As we continue to resume daily activities on a regular basis and question the legality and ethics of interventions on life and health, we realize that in this new year special importance is given to the progressive regularization of central topics and general bioethics.

As noted above, this issue presents three topics that analyze and reflect on bioethical dilemmas at the beginning of life; the first on emerging technologies; the second on the ethical principles of medical research and a third on other dilemmas in medical practice. Two reviews are also presented that describe bioethical problems which require an analysis in the light of current events.

Grimaux and Paez in the first article of this issue of Medicina y Ética, raise a debate on interventions for the treatment of gender dysphoria in adolescents, specifically, the controversy that exists in the suppression of puberty.

The authors’ starting point affirm that gender dysphoria is classified as a mental illness due to the high level of anguish that it generates in those who suffer from it, caused in turn by social rejection. They consider that this situation mentioned above puts adolescents who suffer from it at serious risk, since it leads to severe depression, self-inflicted damage, anxiety and isolation.

The authors outline three intervention models for gender dysphoria: a) therapeutic, b) watchfull waiting and c) affirmative model. On the other hand, describe two therapies for its treatment: a) accompanying psychological therapy and b) suppressive therapies of puberty.

The main dilemma addressed in the article is that puberty suppression therapies may carry significant long-term risks that are not yet fully understood. This, coupled with the fact that most cases return to the original conception of their gender after a while, calls into question the ethics of such interventions for not complying with a therapeutic principle.

In the second article that we present in this issue, Pérez Ferrer, Weingerz and Madero raise a critical issue regarding the legal invalidity of the preemtive will document in pregnant women and its subsequent reactivation once the pregnancy has been carried to term.

The problem that arises is that the invalidity annuls the principle of autonomy of the pregnant woman, denying her the right to exercise her freedom and, therefore, this postulate is criticized by the authors in order to draw attention to this matter and urge to prohibit its invalidity.

The prohibition during pregnancy is based on a desire to safeguard the life of the baby at all costs, but it lacks ethical solidity, since respecting the mother’s decision not to be subjected to extraordinary means may also be compatible with medical actions aimed at saving the baby’s life without trampling on the dignity of either the mother or the baby.

Therefore, prohibiting women from expressing their decision is an attack not only against the principle of autonomy but also against the principle of justice.

On the other hand, Bustos’ article touches on a central theme on which no ethical reflection will suffice due to its relevance: scientific research involving human beings.

For the author, the two pillars on which bioethical principles concerning any research process that involves human beings should be built, are dignity and human rights, being the former the basis of the latter.

After affirming that the objective of medical science is to obtain impartial and true knowledge about reality, the author sets out the criteria with which a research protocol must be governed: protection of life and health, integrity, respect for self-determination, respect for privacy and the confidentiality of personal data.

All these criteria come from human dignity, from which other integrating values of research emerge such as responsibility, service, justice, peace and education.

A relevant clarification made by the author is between dignity and autonomy, stating that the former cannot and should not be subjected to the latter.

Another relevant aspect of the article in question is the detailed list that it offers on national and international documents on the regulations of research with human beings to reinforce the idea that the human person and their dignity as well as the rights of all people must be guiding principles of clinical research and never be taken as mere means.

The fourth article, written by Luca Benvenga, offers a daring consideration on transhumanism by stating that the anthropocentric and technocentric paradigms can be harmonized without generating tension between the human and the artificial.

The author proposes that the incorporation of technology to the human condition is part of the evolutionary process itself, insofar as the human being has always sought to improve his abilities, this being a natural tendency. Now, this fusion of paradigms says the author, is not exempt from ethical questions that deserve serious reflection. These are, what does it mean to be a man? what is nature?

And what is a posthuman? to name a few.

Thus, the article is the result of this dialogue between bioconservatives and transhumanists.

One last article that makes up this issue is Vaquero, Marcos, Mena and Carrión’s article, who present an empirically evidenced analysis of naprotechnology using Sgreccia’s triangular method.

After providing current data on low fertility rates, which puts the assurance of a generational change at risk, they start from the definition of naprotechnology as a restorative science of fertility insofar as this is not a disease as such, but rather the symptom of one or other possible diseases. Its objective, therefore, is to improve the physiological conditions of the menstrual cycle to facilitate natural conception.

The authors support the success of naprotechnology in a case study carried out in Spain between the years 2015 and 2021. The data yielding relevant information is related to the age of the couples, the history of having resorted to some reproduction technique assisted, the diagnosis, the number of children and the success rate that reaches the three hundred pregnancies from which 201 live children have been born.

On anthropological considerations, the second section of Sgreccia’s method, the authors reflect on the unity of soul and body in the human person, sexuality beyond genitality.

Regarding ethical considerations, we reflect on the good that a child represents, the care and protection of the right to physical health, the good of marital health and the spiritual good of man.

The first review, written by Dr. Garibay, carries out an ethical reflection on various topics such as the embryo, abortion, assisted reproduction techniques, genetic manipulation and cloning. An outstanding reflection that the author notes is the invitation made by Dr. de la Torre Díaz on the pre-implantation embryo and on the vulnerability of both the mother and the baby about abortion. Likewise, the invitation not to make moral judgments but rather to offer education and guidance is highlighted.

The second review presented by Dr. Gómez Álvarez deals with the book compiled by Dr. Carreño on euthanasia and assisted suicide where various arguments from different authors are presented; all of them opposing those actions with arguments such as: the difference between freedom and autonomy, the value of human life, the relevance of palliative care, the contagious effect of assisted suicide, the implicit social discrimination in euthanasia, the mutual dependence and responsibility between people, the violation of the principle of non-maleficence, the slippery slope argument, the ethics of care and the due exercise of mercy.