We present this issue of Medicina y Ética that includes topics that continue to generate ethical and bioethical questions that challenge us to try to answer them from rational and academic argumentation. In the first place, the article by doctors Santos and López is presented, which addresses the principle of autonomy from the need to insert it into the family dynamics in decision-making in the clinical field. Given the prevalence of individual autonomy from a liberalist tradition, the authors propose a relational autonomy that considers and actively involves the family as an organized and structured unit that can also participate in ethical decisions.

This is based on the care role assumed by the family in the presence of a sick member. In this sense, the family is constituted as a single body (from christian anthropology and general systems theory), where each member has different functions and roles, but all are coordinated and structurally organized.

The authors then propose a clinical practice guideline that promotes the idea of the family as a body ordered to love which, in turn, rests on two principles: responsibility and totality. With these, the family must ensure the good of each of its members, but also for the good of the unit that is, thus harmonizing individual autonomy with the family.

In the second article, Sagasti poses a dilemma of maximum relevance with respect to the drugs destined to correct cognitive disorders that are used by healthy people with the purpose of empowerment for certain conditions such as the lack of concentration and the affectation of the memory. At the base lies the bioethical question for the therapeutic principle and the ethical justification of said intake. It is in this way that Sagasti describes the three different approaches to these drugs, both in their analysis as a health problem that generates addictions, and in their role as capacity enhancers not necessarily diminished until their conception as “lifestyle drugs”. It is stated that their use is not as serious as the consumption of opioids, in the second, reflection is concentrated solely on the individual consequences that it has for those who decide to consume them for these purposes, and in the third, the problem may represent the transition from individual responsibility to social consequences of greater relevance and impact in the medicalization of daily life.

To argue about the possible ethical justification of the use of enhancing drugs in healthy people, the discussion starts from the questioning of the notions of disease, health and normality; all of them insufficient to delimit between what is ethically justifiable and what is not from the perspective of the therapeutic principle.

This principle, in its classic interpretation, says the author, starts from the disease as an essential condition for its ethical justification, something that, given the fine line between disease and diminished capacities, would be impractical when analyzing the use of said drugs. To this end, the author proposes a different hermeneutic of the therapeutic principle that bases its consideration on what would be most convenient and represents a greater good for each person in their situation without having to resort to universal criteria that go little deeper in particular circumstances.

In the third article, Castillo takes up the complexity of approaching and managing pain in chronic patients or in the terminal stage of human life. The foregoing because pain, affirms the author, is not isolated from other human conditions such as suffering; therefore, it requires not only extensive technical experience in drug management but also excellence in the ethical judgment of the medical professional.

To achieve this articulation of competencies, it is necessary to understand that the management and control of pain is a universal human right that is part of the right to health protection. For this reason, it is necessary to detect and eradicate some bad practices that stigmatize or exclude some patients from pain care, management and control, denying them analgesic treatments or therapies, as well as avoiding the abuse of medications such as opioids. To achieve this, it is necessary to work from the perspective of bioethics and through the application of bioethical principles, to provide and guarantee patient care and pain control without falling into abuse that leads to addiction.

Doctors Ortiz and Holzer, in the fourth article of the magazine, show an extremely painful situation in our country, Mexico, with respect to the increasingly high rates of violence that affect the population’s medical coverage.

It describes how doctors, whether they are social service interns or residents or general practitioners who are sent or obtain their position in certain risky areas and lack of governance, suffer attacks on their person, intimidation, robbery, illicit adjudication of material among other abuses, a situation that affects their work and professional practice.

The authors clarify, however, that it is a reality that Mexico has the lowest rate of doctors per population among OECD countries, which further contributes to the lack of medical coverage in the country that is affected by other factors such as violence. Finally, the State is urged to provide security in risk areas to assigned doctors so that they can carry out their work in a professional manner and adhere to the standards of excellence.

The last article published in this issue reflects on the bioethical notions of the teaching of pope Francis in these ten years of his pontificate. With this, Ortega focuses his attention on global bioethics from the understanding of the necessary interconnection of realities proposed by the Pope in Laudato sí, as well as on the notions of integral ecology, human development, solidarity and solidarity economies.

The author refers to how in these first ten years of pope Francis’ pontificate, he has invited us to build bonds of brotherhood and the care of the Common House from which a social, ethical and bioethical life emerges that, through dialogue, welcomes, cares for and protects life in all its dimensions. Finally, there are two reviews that are presented in this third issue: the first by Guerrero Reyes, who recalls the difficult situation that doctors who are sued for their professional practice go through and analyzes how to make this reality an opportunity for growth. and learning to pay for the figure of the doctor who has been denigrated in the media in recent years.

The second, by Álvarez Gómez, presents a book that questions the ultimate foundations of topics such as the antiquity of the human being and its evolution, the verification of human diversity, the origin of certain diseases, the structure of the human brain and even historical origins. of eugenics. A book, without a doubt, a must-read for those who want to investigate the root causes of ethical, anthropological and scientific problems.