“_This work proposes to analyze, from a plural and decolonial perspective of bioethics, some aspects of violence against transgender women in Brazil. As specific objectives, we propose to reflect on some historical paths that culminated in the understanding of transsexuality, as we understand it in contemporary times and its link with the stigmas and discrimination that pervade this population; identify the different forms of violence suffered by transgender women in Goiás and the Federal District, relating them to violence on the national scene and finally investigate how intervention bioethics can contribute to the debate on violence against transgender women. The work initially demarcates fundamental concepts for the debate such as gender identity, transsexuality, transgenderism, gender and cissexism, also discussing public policies linked to the health of trans people. Some Christian narratives on the topic are also presented so that we can think about their impact on the lives of these women. We use intervention bioethics as an initial theoretical basis to think about the issues of violence against this population as a persistent bioethical problem, but considering that it is important to dialogue with other theoretical references such as the ethics of difference, feminist bioethics and the Universal Declaration on Bioethics and Human Rights. Dossiers with data on violence against transgender people produced by ANTRA and Rede Trans are visited, seeking to bring them closer to the narratives of the 5 trans women interviewed.

“Throughout history, patients with dementia have been subjected to situations of exclusion, victimization and denial of rights, with decisions being made "for" them by family members and health professionals, rather than "with" or "for" them. Currently, participation in decision making is considered essential to provide individualized and patient-centered care. Notably, in the case of Alzheimer’s patients, as dementia progresses, the ability to consider future thoughts and actions is compromised, thus affecting decision-making skills or decision-making ability. This dissertation aims to discuss the possibility of patient participation in decision-making in health care, through the Advanced Care Plan - ACP, which has been defined as a dynamic process of dialogues and record of values, preferences and willingness for health care and future treatments performed among patients, family members and health professionals. The ACP will enter into force when the patient loses his capacity as a means of preserving autonomy and the right to self-determination. Under the methodological bias it is a theoretical and documentary research, whose basis is based on theoretical and normative references from the perspective of Human Rights. The discussion has as ethical pillars human dignity and autonomy contemplated in the Universal Declaration of Bioethics and Human Rights - DUBDH and the Convention on the Rights of Persons with Disabilities - CDPD, beyond the new reference of legal capacity and Supported Decision Making as universal human rights. The research results suggested that the adoption of ACP although challenging, is feasible, especially when considered as a formal mechanism of Supported Decision Making. Therefore, the ACP values and protects the patient as the protagonist of the therapeutic encounter, as well as admits that personal choices are intertwined with the relationships established by each individual.

“The reemergence of cannabis as a medicine is no longer news in the academic world or among the general population; the number of related scientific articles is growing, and its prescription has become more frequent. This revival contrasts with the prohibitionist reality surrounding marijuana, whose prohibition keeps popular and traditional use on the margins, especially by people from the periphery, blacks and indigenous people. Our research aims to analyze, based on Intervention Bioethics and other southern epistemes, the use of marijuana for therapeutic purposes. Through an epistemic perspective of complex thought, decoloniality, inter-epistemic and sentipensante, we discuss the moral, social, racial, health and economic crossings associated with the use of plant in question. This is a qualitative ethnopharmacological research for bioethical analysis that used the methodological tool of participant observation of Projeto de Extensão Ambulatório Cannábico of Universidade Federal de Pernambuco. We observed that the use of cannabis has varied in terms of the clinical indication, the characteristics of the products, the forms of access and the social, economic and cultural aspects of the users. The clinical risks of using the plant medicinally do not seem to justify keeping it banned. On the other hand, regulating only prescribed use has an unjust effect on a portion of the population that benefits from its popular use and on the black population, given the harmful effects of prohibitionism on this group. Bioethics that is critical of the concentration of power and involved in social emancipation cannot shy away from revealing the pacts of whiteness and the capitalist aspects that are essential for maintaining the privileges of a few and the global unprotection of a majority. With a non-speciesist approach, we also consider cannabis to have the right to life integrated with its original function, understanding its persecution as a violation of the right to its existence. Finally, we believe that broader legalization could have more integrative effects for humanity, the plant and the ecosystem.

“The thesis aims to understand hunger in Inborn Errors of Metabolism (Classical Homocystinuria and Phenylketonuria) from a bioethical and socio-sanitary interface, based on the daily experiences of mothers in their interactive social journeys in search of food and nutrition for their children. Inborn Errors of Metabolism represent a group of rare genetic diseases. Phenylketonuria and Classical Homocystinuria are in group 1 - aminoacidopathies of intermediate metabolism disorders in small molecule diseases treatable with lifelong mandatory diet and strict clinical and biochemical monitoring. The treatment of these two rare diseases requires specific nutritional approaches, using metabolic formulas, individualized and lifelong diets, and strict clinical and biochemical monitoring. When untreated, they compromise life and lead to irreversible sequelae from metabolic decompensation. These sequelae include metabolic decompensation, neurological symptoms, developmental and learning impairments, behavioral problems, and involvement of multiple body systems. From a biopsychosocial perspective, individuals with Inborn Errors of Metabolism face challenges in various aspects of their lives. Hunger, which is linked to food, appears in the context of these rare diseases. The thesis relied on five fundamental points: maternal journeys in search of nutrition, Food and Nutritional Security, the human right to adequate food, food, and hunger. Food and hunger are interfaced in the experience of rare diseases. Within the scope of Food and Nutritional Security, every person is guaranteed the right to regular and permanent access to quality food in sufficient quantity, without compromising access to other essential needs. Thus, the condition of hunger becomes an indicator of the violation of the Human Right to Adequate Food. This thesis adopts a bioethical approach with a social perspective and interface with Public Health, using Corbinian Grounded Theory to form substantive theory focusing on maternal illnesses and daily struggles in search of food and nutrition for their children. Data saturation occurred in three sample groups: groups 1 and 2 of brazilian mothers who are part of the EIM health ecosystem, with Phenylketonuria and Classical Homocystinuria, with children aged six months to 12 years affected by rare diseases. Specialist nutritionists in the field composed a third support group (group 3) to deepen clinical and social management in the study context of EIM. Data collection was carried out with two groups of Brazilian mothers (n=27) and specialized nutritionists (n=4). Research diaries, non-participant observation of events on Inborn Errors of Metabolism and rare diseases, sociodemographic forms, and semi-structured interviews were used. The data analysis in axial coding allowed the composition of three categories, 12 subcategories, and 29 dimensions. The Corbin and Strauss (2015) paradigmatic model was the analytical tool used in this research for the coding and theoretical integration process. It uses three components, which are conditions, actions-interactions, and consequences, forming the central category "Hunger for food and relational ecosystemic belonging" and the model named FOMEIM. The formation of hunger in flux to a set of hungers in the socio-sanitary interface combines the materiality of food access and the immateriality of relational aspects. Mothers appropriate the imperative of life and the moral imperative of dietary variety in their maternal journeys in search of food and nutrition for their children. They also adjust in their relationships with food. The materiality of food access is marked by the lack of access in the life contexts of families. The immateriality of relational aspects points to social and food stigmas, conflicts, and tensions in relational interactions, confronting maternal desires for free diets (in the dietary dimension), hope for protein (in the dimension of reducing or curative possibilities of the disease), and the search for common personhood (in the existential dimension) and the ideal of treatment. The relational indicates conflicts and tensions in the face of these maternal desires and anxieties for food and the consolidation of moral imperatives. Organic solidarity networks are spaces of belonging and de-stigmatization for mothers. The politics of experience and the formation of communities of practice characterize the potential agency of women collectively. Reviewing health governance and enhancing the visibility of rare diseases and belonging collectives can help reduce conflicts.”

“Virtues have a long history as essential elements in the field of ethics, dating back to Antiquity, being sidelined in Modernity and eventually revived by philosophers and scholars of moral psychology in the late 19th and early 20th centuries. What has come to be known as "virtue ethics" consists of an ethical model driven by dissatisfaction with the dominant currents, deontology and consequentialism. Bioethics, recent in history, has developed parallel to virtue ethics, aiming to provide practical and consistent responses to ethical dilemmas, particularly regarding health care. The principlist approach of Beauchamp and Childress, with strong deontological and utilitarian roots, has been the target of constant criticism since the 1990s, especially for being a vertical, imperialistic view that does not embrace moral pluralism and limits bioethics to biomedical ethics. With the advent of the Universal Declaration on Bioethics and Human Rights (UDBHR) in 2005, the theoretical framework of human rights was incorporated into the discipline, formulating a current that expanded its principles to 15, aiming to build a more democratic bioethics that would encompass contemporary aspects that had hitherto been disregarded in the field, such as diversity, plurality, and vulnerability. However, it is noted that deontological and consequentialist views have not ceased to influence this current, being also present in the UDBHR. The proposal of this work is, at first, to present the concepts of virtues and their progression from Antiquity, culminating in the contemporary revival called virtue ethics, which presents itself as a structured ethical theory. Subsequently, taking as starting point a theory of applying virtues to medical ethics, developed by Pellegrino and Thomasma in contrast to a principles-based approach originally formulated by Beauchamp and Childress, the integration of virtues into the bioethical epistemology expanded by the UDBHR is discussed. It is argued that, by focusing on the agent and their character, bioethical analysis gains an important asset that aligns with its objectives, contributing to the type of bioethics that the UDBHR promotes. Moreover, the recurrent objections to a virtues-based approach are equally applicable to deontology and consequentialism already accepted by bioethics, which minimally implies parity in the application of theories. It is found, however, that the virtues view promotes something that the others do not, which is human flourishing through the cultivation of excellences that are, by essence, good; this, in turn, contributes to the good development of professionals. Furthermore, it is an approach that encompasses others, rather than excluding them. The combination of virtues, especially with bioethical principles, proves essential to achieve quality and excellence in practices, as they shape the individual's character so that the principles are not just rules to be followed but are followed willingly. Finally, the conclusion that follows from the theoretical path outlined is that contemporary bioethics includes virtues as an additional theoretical framework, as these better consider aspects of individuals' personalities and community practices and traditions, which influence the moral dilemmas faced by the discipline."

The Regulation of Access to Care, as part of the National Policy for the Regulation of the Unified Health System (SUS), is one of the main strategies to put into practice equitable access to health in Brazil. In addition, access to health is a widely discussed topic in bioethics. This research aims, therefore, to bring bioethics closer to the regulation of access to care as a public health policy and practice, with the purpose of valuing the view of bioethics as an important means of ensuring access to health. Therefore, the present study advocates the inclusion of some bioethical categories in the daily work in health: (1) protection of the vulnerable as defined by the Bioethics of Protection; (2) critical solidarity as worked by the Bioethics of Intervention; and (3) Articles 4, 10, 13, 14 and 18 of the Universal Declaration of Bioethics and Human Rights. To achieve this goal, an autoethnographic research was developed, since the researcher worked from 2014 to 2020 in the Regulation sector of the Municipal Health Department of Caruaru, having helped to build public policies that enabled the expansion of access to health at the municipal level.

“Introduction: The emergence of new medications, technological equipment, as well as
improvements in basic sanitation allowed that some historically fatal diseases could become
chronic in these days. So as the aging of the population occurred, the concomitantly increase in
the prevalence of chronic diseases happened. This triggered the imbalance between demand and
supply of hospital beds, especially intensive care beds, highlighting the need to reassess the care of
patients with a low probability of clinical recovery. Therefore, palliative care should be considered
and discussed with patients and their families, aiming at a better quality of life for the patient.
However, conflicts related to end-of-life care and the limit of intensive support for terminally ill
patients still exist. Objective: This study aims to assess the challenges perceived by intensive care
physicians at SES-DF regarding palliative care in ICUs, based on the bioethical prism of the
principles of human dignity, autonomy and consent. In addition, we sought to describe the most
likely conduct regarding the use of artificial life support in end-of-life situations; identify whether
the dignity, autonomy and consent of the patient and family would be considered in decisionmaking
at the end of life; and to analyze the knowledge and application of the Guideline for
Palliative Care for Critical Patients in the ICU of the SES – DF in these respective ICUs. Method: Descriptive and observational study. Twenty physicians answered to online questionnaires, which were made available via Google forms link to SESDF intensive care physicians. These questionnaires had themes as socio-demographic and occupational content, knowledge on bioethical principles, as well as on palliative care and its implementation in ICUs. The data obtained were statistically analyzed using the Excel and Statistical Package for Social Sciences – SPSS programs. Results: Among the participants, 55% (n=11) were female, 45% (n=9) had residency in intensive care medicine, 45% (n=9) worked in the ICU for more than 16 years and 25% (n=5) between 5 and 10 years. A total of 23 challenges faced by intensive care physicians in providing palliative care in ICUs in the Federal District were identified, highlighting the difficulty in adjustment of therapies to new goals of care of patients in the terminal process. It was detected that human dignity, autonomy and patient and family consent were considered in decision-making in ICUs, but there is a possibility of improvements in these aspects. However, it was noticed that the SES-DF’s guideline is not widely known, nor is it routinely used in the services. Discussion and conclusion: There are a great need for training and qualification of the entire team (medical and multidisciplinary) in palliative care and communication skills to adjust and improve therapeutics that benefit the patient. In this way, there will be more chance to execute treatments centered on the patient. The creation of hospital clinical ethics committees and encouragement for health professionals to integrate them is a factor that can increase education, reflections and provide care centered on bioethics”

Since 2009, the observation of mortality rates among the transgender population has shed light on a distressing reality in Brazil, where the largest number of murders of transgender individuals has been recorded. However, it is crucial to recognize that the mortality rates within the LGBTQIA+ community, particularly among trans women, did not arise in recent years. Rather, they are a manifestation of a coloniality model that has historically been employed in the Americas to exert control over women and diverse bodies. Despite some existing public policies, their effectiveness in ensuring the safety of LGBTQIAPN+ individuals remain insufficient. In fact, these policies experienced a decline in their efficacy between 2018 and 2022, coinciding with the election of conservative politicians who capitalized on fake news, homophobic rhetoric, and the vilification of a perceived adversary. Importantly, it should be acknowledged that this model of control is not exclusive to Brazil, as it permeates other countries as well. In this research, we undertake an analysis of the history, culture, and lives of transgender individuals to comprehend the construction of necropolitics—the politics of death—and explore how intervention bioethics can contribute to its mitigation. By examining the experiences of trans people, we aim to gain insight into the mechanisms underlying the perpetuation of violence and discrimination, and ultimately propose strategies to counteract them using the Intervention Bioethics (BI).

While the development of science and technology provides solutions to old problems, it also gives rise to new threats to the lives of humans and other living beings. The role of bioethics in the face of the paradox inherent in the biothechnoscientific paradigm is to provide moral reflection on the impacts that the effects resulting from biotechnological advances can have on life in its broadest sense. For some years, ionizing radiation emitting devices have been implemented in Brazilian prisons as an indirect tool for body inspection, aiming to identify prohibited or illicit objects that may be concealed in the bodily orifices of visitors. While there is a supposed security benefit one hand, there is also a health risk to the subjects targeted by the device, especially if the principles of radiological protection are not respected. Hence, this study focuses on the use of ionizing radiation -emitting body scanners in Brazilian prison facilities from a bioethical perspective. It proceeds by following itinerary: it begins with a description of the demographic profile of prisoners and their families and discusses the context of Brazilian prison system in the light of criminology, sociology, and bioethics. It highlights the chronic problems like a series of violations of the fundamental rights deprived of their liberty and, extensively, of there families during visitation. Subsequently, it elaborates on the use of body scanners, considering the regulations in Brazil and other countries. It reviews the biological effects of ionizing radiation, with an emphasis on stochastic effects, and presents the principles of radiological protection advocated at the international and national levels, highlighting points of convergence with bioethical principals. It then presents the Universal Declaration on Bioethics and Human Rights and emphasizes the principle of benefit and harm, article 4 of the declaration, from a philosophical and bioethical conceptual approach. Finally, it analyses the use of the equipment in the light of bioethics and, above all, relies on the principle of benefit and harm as the primary tool for reflection on the risks associated with radiation, which can potentially be exacerbated by the failure to comply with radiological protections guidelines. It chooses this tool due to its broad scope, addressing not only biomedical issues but also social, economic, and political ones. The study concludes by proposing paths to be taken in pursuit of maximizing benefits and minimizing harm in the current context. In this way, the study directly contributes with intervention suggestions aimed at protecting the subjects targeted by body scanners and indirectly raises the debate on the chronic and neglected problems of the prison system.

“The use of genetic profile analysis as well as the creation of these databases for the purposes of criminal prosecution established a new form of investigation, eager for the resolution of crimes, homicides and rapes. However, it appears that, in Brazil, the collection and analysis of genetic material in criminal investigation, linked to Law No. 12,654/2012, raises questions about persistent conflicts in the face of mandatory submission to identification by genetic profile for criminal purposes. The second instance decisions of the Brazilian provincial courts were analised, taking into account only the documents and sentences that were related to the identification by the genetic profile, in order to establish its main points of conflict and limiting and determining aspects in the ethical and legal by through a descriptive analysis and association statistics. The courts were showed a convergent position regarding the right to refuse the collection of biological material on the grounds in judgments of condemnatory decisions that were not yet final, from the perspective of identifying the genetic profile of those convicted of the crime of drug trafficking, of nonretroactivity of the law and the violation of the right to privacy and respect for the principle of innocence and non-self-incrimination, and also as a condition for regime progression. In addition, the results shed light on the lack of equity of decisions in which common factual situations were presented in the face of gaps in the norm. In this way, the violation of the right to privacy and the bioethical aspects linked to the dignity of human person are still questions faced by the courts due to the impositions of the law. Such conflicts related to mandatory genetic characterization were discussed through the support of human rights to bioethics. The genetic profile bank is an important resource for the investigation and prevention of crimes, but its maintenance must be associated with an ethical balance between the interests of society and the violation of rights linked to its establishment, in this way, the experience of human rights serves as a solid and ethical foundation for the search for this balance._”

“ Psychic suffering in childhood and adolescence can threaten the capacity and potential for healthy growth and development, especially in contexts of vulnerability, where the numerous inequalities and social inequities in Brazil stand out. The legal landmark established by Law no. 10.216, of 2001, and the Ordinance no. 336, of 2002, from the Ministry of Health, include as a strategic action in the expansion of access to mental health for children and adolescents, the psychosocial, territorial, and community care model. In this reordering, _where the numerous inequalities and social inequities in Brazil stand out. The legal landmark established by Law no. 10.216, of 2001, and the Ordinance no. 336, of 2002, from the Ministry of Health, include as a strategic action in the expansion of access to mental health for children and adolescents, the psychosocial, territorial, and community care model. In this reordering, the family takes on a strategic position of caring for the person who suffers, sharing this responsibility with the State and the society. This study aimed to analyze the intersectionality of the vulnerabilities of family members of children and adolescents in psychological distress. This is a descriptive exploratory research, of qualitative approach and anchored in the theoretical references of bioethics, public policies and mental health of children and adolescents. For data collection, semistructured interviews with 14 family members were made in two services of the Child and Adolescent Psychosocial Health Care Network of the Federal District. The content of the interviews was submitted to lexical analysis using the Iramuteq software and Bardin's content analysis technique. The raw corpus submitted for textual classification analysis by the Iramuteq software, identified 4 classes of words, which are presented with denomination of the thematic categorization assigned and the and the respective percentage distribution of the corpus: Class 1, Vulnerabilities in women's life stories (26.44%); Class 2, Vulnerabilities present in the daily care of family members (26.68%); Class 3, Vulnerabilities related to access and health care of children and adolescents in the RAPS devices (25.8%) and Class 4, Vulnerabilities of children and adolescents in the school environment (21.07%). The main results reaffirm the historical role of women as primary caregivers and life stories, in general, marked by contexts of multiple vulnerabilities. There is evidence of an intersectional overlapping of race, gender, and social class, generating subjective and material experiences of oppression and exclusion processes throughout their trajectories. The retraction of the State in the protection of children and young people is aggravated, from 2016, by the creation of new policies that are characterized by the dismantling of the advances of the psychiatric reform achievements, resuming approaches of medicalizing, normalizing, prohibitionist, and segregating logic approach. The State's lack of social protection is evidenced by the numerical insufficiency of CAPSi devices and other care devices of the psychosocial and intersectoral care network, as well as the lack of qualified professionals for the psychosocial approach, constituting vulnerabilities that reverberate as physical overload and psychic for the family. These aspects constitute important bioethical conflicts, in which, the analytical categories liberation, empowerment and emancipation of intervention bioethics indicate paths that enable the break with the oppressive forces, seeking to ensure essential elements for citizenship, through the construction of a democratic and participatory praxis, which has as its fundamental assumption the development of autonomy, freedom and social justice. _”

"According to the latest thematic report from the World Health Organization (WHO, 2019), more than 700,000 people die by suicide every year. Despite being invisible, epidemiological data highlight suicides among vulnerable populations, which seem to carry death as a life expectancy. Extrapolatingthe relevance of subjective factors and the medicalizing discourse of the act, this work problematizes the principle of autonomy, at the same time that it highlights politics as a moderating force of the will to live. The objective was to produce a bioethical-political analysis about the phenomenon of suicide, from the colonial statute to the neoliberal regimes. Neoliberalism, whose aim is to remodel the State and transform subjectivities (in adequacy or extinction), imposes the market-form as a mode of existence, exacerbating inequalities, conditions of precariousness, exclusion and failure of social ties. Under the colonial heritage and soil, Brazilian-style neoliberalism, historically supported by the apparatus of violence, makes it a guiding and determining axis in the management of life and death. In this current logic of “war”, of warlike relations, including with oneself, suicide is guided as part of the package, of the tricks and agency of death policies. Based on the idea that suicide and its preventioare not carried out in the first person, this investigation responds to a commitment to articulate, expanand affirm life possibilities, especially through public policies and the collectivization of care".

“In Brazil, the reporting system for adverse events related to healthcare assistance was established with the aim of 

improving the healthcare system. This system is considered one of the pillars of risk management in 

healthcare services. Notifications are confidential, and the notifying professional must be assured of the right 

to privacy. OBJECTIVE: To study this reporting system, using the 4Ps of Intervention Bioethics - prudence, precaution, prevention, and protection - and articles from the UNESCO Universal Declaration on Bioethics and Human Rights (DUBDH) as the theoretical and normative basis for argumentation, METHODS: The study was conducted using qualitative research methodology, carried out in two stages: initial integrative literature review, followed by empiricalbehavioral data collection with key actors, for subsequent discussion to gain a better understanding of the issues affecting the adverse event notification system. The Integrative Literature Review aimed to explore studies that address the 4Ps of Intervention Bioethics and specifically selected DUBDH articles. The empirical phase of the study involved data collection using a questionnaire composed of open-ended and closed-ended questions. The questionnaire responses were analyzed by using NVivo software, following Bardin's content analysis logic. RESULTS: The review indicates that there is no significant production of publications that address the proposed question for searching references related to the categories of "vulnerability" and "protection." The responses from the research participants highlight an emphasis placed on the references to responsibility in reporting and healthrelated harm, both of which are principles directly linked to risk management. On the other hand, little emphasis is placed on respecting autonomy and vulnerability throughout the process of reporting adverse events. DISCUSSION: The application of the 4Ps in an organic, sequenced, and well-founded manner appears to be possible and appropriate for resolving conflicts related to the adverse event notification system in Brazil. Expanding the concept of vulnerability and protection as advocated by the 4Ps involves considering each case specifically, as well as the various contexts of the individual and the collective. Intervention Bioethics encompasses relevant categories for argumentation and solutions to various moral dilemmas involving vulnerable individuals and groups, while also centrally addressing the public responsibility of the State towards its citizens. CONCLUSIONS: The 4Ps of Intervention Bioethics, when appropriately used, serve as valuable and practical tools for justifying potential solutions to conflicts arising from the functioning of the adverse event notification system in healthcare in Brazil. Expanding and enriching the concepts of vulnerability and protection as advocated by the 4Ps and the DUBDH means acknowledging the vulnerability of patients and 

Health Technology Assessment consists of a multidisciplinary process that determines the value of a health technology with the aim of informing decision-making for the formulation of safe, effective and patient-focused health policies by determining which interventions should be made available to the population in a rational way, promoting an equitable, efficient and quality healthcare system. Patient participation in HTA contributes to more efficient solutions in the distribution of scarce health resources and better quality care; legitimizing, democratizing and making the process more transparent. The patient's right to participation in the health sphere derives from the human right to health and requires States to implement various mechanisms to make it possible. The Patients' Human Rights refer to the application of human rights to all individuals undergoing health care, such as: the right to life; the information; health, participation in public policy, etc. Examining systematic factors and State responsibilities in the provision of health care, the Patients' Human Rights framework is designed as a bioethical analysis tool capable of contributing to the examination and solution of issues related to health care. Because patients have the right to participate in the planning and delivery of their health care, and the HTA process determines what health goods and services will be made available to them, it follows that patients have the right to be heard as part of the process of HTA. This thesis, based on the use of Patients' Human Rights as an ethical reference committed to the protection and promotion of patients' rights, presents as a contribution elements to discuss patient participation in the patient perspective modality in HTA in Brazil Unified Health System by Conitec. To this end, analyzes of documents made available by Conitec were carried out on the process of participation and evaluation of the patient's perspective from December 2020 to December 2022 in the incorporation of health technology on rare or ultra-rare diseases. Although some challenges are present in implementing the patient's perspective as a form of active, effective and direct participation of patients and their inputs in HTA, it is understood that its use can be improved based on reflections of the elements tha constitute the Patients' Human Rights, contributing to establishing a more legitimate and democratic evaluation process, in addition to adequate public policies and an organizational culture guided by human rights

“Introduction: Care for post-discharge patients from the pediatric intensive care unit (PICU) is a subject that has been researched due to the increased survival of patients with chronic and complex health conditions and who need continuous and integrated health care. Due to the need to verify the functional conditions of patients after discharge from the pediatric intensive care unit, the Functional Status Scale (FSS) functional performance assessment scale was included in the physiotherapy assessment form as of September 2019. FSS includes six domains: mental status, sensory function, communication, motor function, eating, and respiratory status. Objective: Reflect, from the perspective of bioethics, regarding the care and social responsibility directed to patients with complex chronic health conditions, after discharge from the PICU, through the FSS scale. Method: Retrospective documentary study of descriptive nature. The functional scores of patients who were discharged from the PICU and who returned to the outpatient clinic in 2020 were recorded in a spreadsheet prepared by the researcher and classified according to the degree of functional impairment, which ranges from 06 to 07 (adequate function); 8 to 9 (mild dysfunction); 10 to 15 (moderate dysfunction); 16 to 21 (severe dysfunction) and above 21 (very severe dysfunction). Patients with FSS ≥ 8 at PICU discharge were selected. Among these patients, the baseline diagnosis was verified in order to verify how many had a complex chronic health condition, according to the Pediatric Complex Chronic Conditions Classification System Version 2: Updated for ICD-10 and Medical Technology Dependence and Transplantation complex. Results: The sample consisted of 349 individuals, 56% of whom were male, with an average of 4 years of age. Regarding functional status at discharge from the PICU in 2020 (n=349), 77% had adequate functionality, 5% mild dysfunction, 11% moderate dysfunction; 5% severe dysfunction and 1% very serious dysfunction. A total of 81 patients had a global FSS score ≥ 08 at PICU discharge, with 23% mild dysfunction, 48% moderate dysfunction, 23% severe dysfunction and 6% very severe dysfunction. The median of the FSS global score was 12 [8 - 28] and higher scores in the domains “motor function” 3 [1 - 5] and “feeding” 4 [1 - 5], which means, respectively, moderate impairment of function motor function and severe nutritional impairment. Among these 81 patients, 68 had complex chronic health conditions prior to admission to the PICU, 27 of which were neurological conditions; 07 cardiovascular conditions; 24 congenital anomalies or genetic defects; 09 premature babies; 01 liver transplant. Conclusion: With this research, it was possible to verify the functional score and the most compromised functional domains of the patients discharged from the PICU in the year 2020, characterizing the functional status of patients with complex chronic health conditions, in addition to identifying the patients who were discharged from the PICU, with an FSS score ≥ 8, and who did not return to the outpatient clinic. In view of these results, the FSS scale can be an indicator of health and quality of care for screening patients who will be treated at the discharged outpatient clinic, since it is important to follow up these patients after discharge from the PICU in order to verify the functional demands, as well as promoting the implementation of measures that guarantee the continuity and quality of care offered to this population.

The Covid-19 pandemic has shown that research ethics and the quality of science and technology produced are inseparable. Therefore, a system capable of evaluating and effectively monitoring the development of research with human beings is essential. This work presents a comparative analysis between the current ethical regulation in research with human beings in Brazil, Resolution CNS 466/2012, and Bill 7082/2017 (in progress) on the subject. The alleged irregularities on the study “The Proxa-Rescue AndroCov Trial”, reported by the official letters No. 829/2021/CONEP/SECNS/MS and No. 951/2021/CONEP/SECNS/MS, were used as analysis parameters. The regulation in force and the bill in progress were compared with regard to the prediction of ethical problems whose indications were pointed out in the official letters, the monitoring mechanisms, and eventual measures derived from noncompliance. As a result, it was found that both regulations had legal previsions for the ethical problems used as comparison parameters and only the bill explicitly had measures derived from noncompliance. However, none of the instruments offers the necessary support to the system to carry out the ethical monitoring of research. Additionally, the bill, specially after the amendments it received through the Chamber of Deputies, weakens the protection of participants and the obligations of researchers and sponsors. The conclusion, after analyzing the history of the National System of Ethics in Research with Human Beings, is that the normative changes, instead of expanding the capacity for effective monitoring of research, have moved the system away from its main objective, which is to protect the participants.”

Population aging has grown in Brazil and around the world. The increase in diseases that affect cognitive functions and increase the demand for care in different areas of life, makes it urgent to carry out and deepen discussions regarding the autonomy, vulnerability and protection of the elderly. Ageism contributes to the idea that elderly people are incapable of making decisions about their own lives, leading to paternalistic attitudes of family members, health professionals and society. This thesis aims to critically discuss the use of curatorship, aimed at elderly people in Brazil and its impacts on the exercise of personal autonomy in decision-making inherent to health care and other fields of life. From the methodological point of view, it is a theoretical and documentary research, whose basis is based on theoretical and normative references of Bioethics, from the perspective of Human Rights. The thesis contextualizes the Brazilian scenario regarding aging, indicating the existence of different forms of stigma, prejudice and discrimination towards the elderly. As a mainstay of the discussion, it addresses the following references applicable to the elderly: autonomy and vulnerability; guardianship, decision-making capacity and legal capacity; and Supported Decision Making (SDM). It also presents the Brazilian judicial and legislative scenario inherent to guardianship and SDM, bringing international perspectives and advances on the subject. In addition, the study uses the concepts of empowerment, emancipation and liberation, from the perspective of Intervention Bioethics, in order to present concrete answers to the problems existing in Brazil in this area. Considering that legal capacity and SDM constitute universal human rights, the results achieved by the research demonstrate that the practice of guardianship in the country has been carried out in the form of paternalistic actions that affront rights and go against the promotion of the real autonomy of elderly people. The attempt to implement changes in the Brazilian scenario, in this particular, has been facing different ethical, cultural, legislative and social obstacles. In this sense, the thesis sought to indicate some points that may contribute to changing the current scenario, among them: carrying out more research related to aging, especially in situations where dementia is present, including proposals for new ways of providing support to the elderly people in their decision-making; the formulation of public policies aimed at better integration of the elderly into the social body; and the alteration of Brazilian legislation, necessarily accompanied by social changes, all this in the sense of building a culture focused on the support of the elderly, backed by the relational conception of human life, as well as the recognition of their abilities and autonomy as a promotion.

“This thesis brings a panorama on the transformation of childbirth assistance in the city of Cavalcante, Goiás. Its main purpose was to find out and analyze reasons why Traditional Birth Attendants - TBAs - are no longer assisting women in labor in town, and how they experience the current model of assistance. In order to understand this local context, a thorough research was made into the history of birth attendance in Brazil and into the current parturition scenario in this territory, with information extracted from analyses of official data files and scientific articles. The local research consisted mainly of field work since 2018 until 2022. 107 interviews were made with women, TBAs, teachers, community health agents, health professionals and administration; as well as a collection of data in official files on the city’s recent childbirth assistance history. This research outlines the memory of parturitions and labor aidances in Cavalcante throughout the last 150 years. The results inform us about the transition from a model of traditional communitarian birth assistance to an unterritorialized model of hospitalized childbirths. Among the evident effects of this transition, the most significant ones include: community disarticulation ; lack of assistance for women; disqualification of TBA’s knowledge, and the deterritorialization of birth. The analysis of such effects, followed by the historiography of childbirth assistance, allowed us to discuss a process of epistemicide of traditional labor attendance knowledge through the imposition of a birth monoculture. However, this monoculture is still not absolute, and based on what was expressed from women about what health is to them, it was possible to sketch out ideas that aim to regenerate diversity. The example of Cavalcante adds comprehension to this transformation also seen in other Brazilian rural areas. It indicates actions that might improve women’s lives and shows strategies in order to keep traditional labor attendance knowledge alive.”

“_This research aims to understand the suffering of youth based on two phenomena: drug use and suicide. Through Bioethics and Listening, the proposal is to analyze the relationship between these sufferings and the formative structures of the modern Brazilian State. It is a qualitative research conducted during the Health and Safety at School Course, in the year 2019, and it aimed to dialogue with 56 high school students from the public school network of the Federal District about the prevention of alcohol and other drug use and suicide. During these dialogues, the students' narratives depicted violences that generated daily suffering and that are related to state structures such as racism, patriarchy, and the militarization of life. As considerations, the importance of understanding suffering, not only as an individual problem, but as a consequence of the modern capitalist world system, for the understanding that suffering is collective reveals the political face of the problematic about the mental health of Brazilian youth and seeks ways to confront this issue. _”