Saúde, Ética & Justiça is an official organ of the Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho da Faculdade de Medicina da Universidade de São Paulo. It is a scientific journal that publishes original and unpublished articles that contribute to the expansion of knowledge on themes that involve articulations between the fields of Health and Justice, as well as on Bioethics.
Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica e Medicina do Trabalho.
Autores que publicam nesta revista concordam com os seguintes termos: Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista. Autores têm autorização para assumir contratos adicionais separadamente, para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.
Limits to life and human dignity: a bioethical and legal perspective in Health Law
The advancement of medicine has significantly expanded the ability to prolong biological life, intensifying ethical and legal dilemmas concerning the limits of therapeutic intervention and the preservation of human dignity at the end of life. This article analyzes, from the perspectives of health law, bioethics, and fundamental rights, the normative and theoretical foundations underlying the right to a dignified death, in contrast to the traditional conception of the sanctity of life. This is a qualitative theoretical study based on a narrative literature review, analysis of legal and regulatory provisions, and examination of recent case law from the Brazilian Federal Supreme Court, the Superior Court of Justice, and resolutions issued by the Federal Council of Medicine. The findings reveal the absence of specific federal legislation on the subject, as well as the insufficiency of public policies on palliative care, both of which compromise the effective exercise of patient autonomy in terminal illness. Nevertheless, an important jurisprudential evolution can be observed regarding the recognition of the refusal of futile treatments and the validity of advance healthcare directives. In light of the theory of fundamental rights, particularly the balancing between the right to life and human dignity, the study concludes that the Brazilian legal system must advance toward the development of a regulatory framework capable of ensuring an ethical, legal, and humanized approach to the dying process, integrating bioethics, patient autonomy, and effective public policies.
Copyright (c) 2026 Otavio de Marco Dala Rosa https://creativecommons.org/licenses/by/4.0
Causation in medical civil liability: conceptual differences between Law and Medical Expert Assessment (factual and legal causation)
Medical liability generally requires proof of fault, damage, and causation. In litigation involving physicians’ liability for alleged medical malpractice, expert evidence is often indispensable, since the assessment of professional conduct and the determination of the connection between the alleged act and the resulting harm demand specialized scientific and technical knowledge. However, the determination of causation encounters epistemological and semantic barriers, as Medicine and Law adopt different definitions of the same phenomenon. This article examines the conceptual divergence between the medico-legal expert approach to causation and its legal concept. It argues that medical experts tend to define causation as factual causation, based on the biological plausibility linking an event to an injury, while overlooking the fact that, in medical liability disputes, establishing a breach of the applicable standard of care is generally indispensable. In other words, the relevant causal nexus must connect a breach of the applicable standard of care to the resulting damage; a mere biological connection to an adverse outcome is insufficient. The article further contends that this terminological dissonance, when left unaddressed, may mislead courts by transforming purely pathophysiological relationships into grounds for civil liability, even in the absence of any violation of the leges artis.
Opinion article/ theoretical considerations
Copyright (c) 2026 Gabriel Fernandes de Carvalho Schmidt https://creativecommons.org/licenses/by/4.0
Advance directives in Brazil: between normative effectiveness and the limits of end-of-life autonomy
Advance directives constitute a central instrument for ensuring patient autonomy in end-of-life decision-making. In Brazil, their regulation is primarily grounded in Resolution No. 1.995/2012 of the Federal Council of Medicine, within a context marked by the absence of specific legislation, yet progressively expanded by other institutional frameworks, including the possibility of formalization through notarial registration, ethical recognition within the field of nursing, and the incorporation of related principles into palliative care guidelines within the Brazilian Unified Health System. This study aims to critically analyze the normative effectiveness of advance directives and the limits of their application in clinical practice from a bioethical and legal-institutional perspective. It is a qualitative, exploratory, and analytical study based on a review of scientific literature and documentary analysis of ethical and legal norms. The findings indicate that, despite the formal recognition of patient autonomy within the Brazilian normative framework, its effective implementation remains significantly constrained by structural factors, including legal uncertainty, the absence of clinical care protocols, gaps in professional training, the persistence of paternalistic models of care, and inequalities in access to palliative care. The analysis demonstrates that end-of-life autonomy remains predominantly formal, lacking the institutional conditions necessary for its effective realization. The study concludes that the effectiveness of advance directives depends on the articulation of legislative advances, the strengthening of public policies, and the transformation of healthcare culture to promote an autonomy that is effectively exercised and consistent with the principle of human dignity.
The Informed Consent as the cornerstone of the physician–patient relationship in medical treatments and procedures: the Theory of Singular Consent as a doctrinal proposal
The physician–patient relationship is among the most significant of human relationships, as it involves the patient entrusting the physician with what is most fundamental: life, health, and the continuity of existence itself. In this context, informed consent is not merely a legal requirement but a foundational ethical principle that should underpin all clinical practice. This conceptual legal analysis proposes the Theory of Singular Consent, according to which informed consent in the physician–patient relationship constitutes a legal process for the formation of the patient’s autonomous will rather than an isolated documentary act. In the international context, informed consent is understood not merely as a safeguard against unauthorized interventions but as a mechanism that promotes patient self-determination. Based on this central thesis, the paper identifies a structural misalignment between medical ethics, law, and clinical practice and proposes an operational model termed the Living Consent Pathway, consisting of ten stages that document the entire process of shared decision-making between physician and patient. The international literature on shared decision-making and patient decision aids demonstrates that clinically valid decisions depend on understandable information, active patient participation, and alignment with the patient’s values and preferences. This analysis draws upon the bioethical principles advanced by Beauchamp and Childress, applicable Brazilian legislation, and recent data from the National Council of Justice regarding the increase in medical malpractice litigation in Brazil. The enactment of the Patient Rights Statute (Law No. 15,378/2026) further reinforces the procedural, relational, and revocable nature of consent, in full accordance with the proposal advanced herein. The analysis concludes that the Informed Consent Form does not constitute consent itself but rather serves as documentary evidence of a singular process: one constructed for a particular patient, within a specific therapeutic relationship, at a given moment. Any other form is merely a signature.
Copyright (c) 2026 Meriele Cristina de Oliveira https://creativecommons.org/licenses/by/4.0
Socioeconomic vulnerability and the impact of legal stringency on infanticide and abortion
Introduction: Throughout history, infanticide has exposed the complexity of societal responses to a crime that challenges notions of motherhood and the vulnerability of birth. Efforts to understand this dynamic and to design interventions have been accompanied by a declining trend in cases in developed countries. The adoption of preventive policies appears to be a key factor in this shift, with access to legal abortion being considered one of them. Objective: This study seeks to examine the relationship between levels of human development and legal frameworks governing infanticide and abortion, focusing on accessing whether legal abortion may contribute to reducing infanticide rates. Method: This documentary study analyzed the criminal codes of 54 countries with very high and low Inequality-Adjusted Human Development Index (IHDI) scores. Laurence Bardin's content analysis method was applied to code and categorize the data, enabling the identification of patterns and cross-country comparisons. Results: The findings indicate that in countries with very high IHDI, infanticide tends to be more narrowly defined, and most of these countries have more permissive abortion laws, with comparatively lenient penalties for both. In contrast, countries with low IHDI exhibit stricter legal frameworks, with more severe penalties and restrictive abortion laws, contributing to high rates of unsafe clandestine abortions and increased maternal vulnerability. Conclusion: The concordance between the broader context in which abortion and infanticide occur and the relationship between legal stringency and socioeconomic vulnerability suggests a possible scenario in which abortion laws may act as a mitigating factor for infanticide in countries with low IHDI. However, it is essential to recognize that unresolved issues surrounding legal abortion continue to directly influence its effectiveness.
Copyright (c) 2025 Patricia Karline Rojas https://creativecommons.org/licenses/by/4.0
Symptoms of depression, anxiety, and stress among physicians: a scoping review
Introduction: Physicians’ mental health has received increasing attention, particularly following the COVID-19 pandemic, which intensified emotional and occupational demands. Identifying symptoms of depression, anxiety, and stress, as well as their associated risk and protective factors, is essential to inform preventive interventions. Objective: To review recent literature using the Depression, Anxiety, and Stress Scale – 21 items (DASS-21) to assess these symptoms among physicians, comparing prevalence across specialties, countries, and work settings. Methods: A literature review was conducted in the PubMed database between September and November 2024. The following search terms were used: (depression OR depressive disorder OR anxiety OR angst) AND (physician) AND (DASS), with a filter for publications from the past five years. Studies including physicians as participants and employing the DASS-21 were considered eligible. Of the 94 articles identified, 15 met the inclusion criteria. Results: The prevalence of moderate to severe depressive symptoms ranged from 9% to over 50%, with higher levels observed among resident physicians and professionals working in high-acuity settings, such as emergency departments and COVID-19 hospitals. Anxiety showed even higher prevalence rates, exceeding 60% in high-pressure environments. Stress, although presenting lower absolute values, demonstrated a more chronic pattern. Identified risk factors included female sex, younger age, high workload, low social support, and direct exposure to COVID-19 patients. Protective factors included male sex and greater professional experience. Conclusion: The findings indicate a high prevalence of emotional symptoms among physicians, reinforcing the need for preventive strategies, support measures, and continuous monitoring of mental health.Parte superior do formulário
Copyright (c) 2025 Lara Vendramini Lucas de Freitas, Felipe Gabel, João Silvestre Silva-Junior https://creativecommons.org/licenses/by/4.0
Contribution of medical expert reports as technical evidence in judicial decisions on pterygium surgeries: a jurisprudential analysis from 1997 to 2022 in the state of São Paulo
Pterygium is a triangular fibrovascular subepithelial growth extending from the conjunctiva onto the cornea. In advanced cases it may cause astigmatism, ocular irritation, and visual impairment, often requiring surgical removal. Pterygium excision is indicated when the lesion threatens the visual axis or produces significant symptoms; however, the procedure carries a substantial risk of recurrence if proper techniques are not employed (recurrence rates can reach ~50–60% without appropriate surgical methods). In this context, unsatisfactory outcomes or complications may lead to malpractice lawsuits. This study examines the influence of court-ordered medical expert reports on judicial decisions in such cases. A jurisprudential review was conducted of the São Paulo State court from 1997 to 2022, identifying 34 appellate judgments exclusively related to pterygium surgeries. All cases involved judicial medical expert examinations aimed at clarifying disputed technical issues. The results show a high degree of alignment between expert findings and court verdicts: in 88% of the analyzed cases, the judges’ decisions were consistent with the experts’ conclusions, indicating that, in most instances, the courts ruled in accordance with the forensic reports. In 100% of the cases in which the expert found a medical error, the defendant was held liable, underscoring the decisive weight of expert evidence when negligence is established. Conversely, in 12% of cases (4 lawsuits) discrepancies were observed: although the expert report did not find malpractice, the court’s decision still imposed liability on the physician or healthcare institution. Notably, there were no cases in which the expert identified an error and the defendant was acquitted. Conclusion: Expert technical evidence plays an essential role in clarifying allegations of error in pterygium surgery and decisively contributes to judicial reasoning. The strong correspondence between expert opinions and verdicts demonstrates that judges usually rely on forensic reports when forming their conclusions. However, cases resulting in liability despite the absence of expert-identified fault suggest that other legal factors may influence judicial outcomes – such as distinct theories of civil liability (strict vs. fault-based), breach of the duty of informed consent, or the principle of the judge’s free evaluation of evidence. Overall, this study highlights the importance of integrating Legal Medicine and Law: while qualified forensic medical examinations provide indispensable technical grounding for the courts, final judgments may also reflect legal reasoning beyond strictly scientific evidence. Attention to these divergent cases and further dialogue on how to balance expert evidence and broader legal standards are recommended to ensure fair and well-substantiated rulings.
Copyright (c) 2025 Victor Ales Rodrigues, Gabriel Fernandes de Carvalho Schmidt, Moacir Bueno Marques, Daniele Muñoz, Eduardo Costa Sá https://creativecommons.org/licenses/by/4.0
Judicialization and access to medicines: implications of Binding Precedent No. 61 and Brazilian Federal Supreme Court Themes 6 and 1234
The judicialization of health in Brazil reflects the challenges faced by the Unified Health System (SUS) in meeting demands for innovative medications and treatments, leading citizens to seek judicial intervention. While essential in cases of state omission, judicialization can jeopardize the system's sustainability by reallocating resources from public health policies. Binding Precedent No. 61 seeks to balance individual rights and financial sustainability by establishing criteria such as the medication's efficacy, the absence of therapeutic alternatives within the SUS, and the patient's financial inability. This directive promotes greater consistency in judicial decisions but has been criticized for restricting emergency access to innovative treatments. Beyond judicial rulings, it is crucial to strengthen the SUS through investments in innovation and the streamlining of technology incorporation processes, ensuring that the right to health is universal and not contingent on judicial action.
Access to Essential Medicines and Health Technologies
Copyright (c) 2025 Stefany de Lima Gomes, Caroline Nogueira de Moraes, Marcelo de Castro Meneghim https://creativecommons.org/licenses/by/4.0
Use of bulletproof vests by police officers and their implications
Introduction: Ballistic vests are essential for protecting police officers during armed confrontations and have proven effective in reducing fatal injuries. However, prolonged use can lead to pain and fatigue, potentially impairing occupational performance, given the physical demands of police work. Objective: To analyze the effects of wearing bulletproof vests on the physical health, well-being, and performance of police officers. Method: A literature review was conducted using the PubMed database covering publications from 2019 to 2024. Studies addressing protection, physical performance, comfort, mobility, and biomechanical aspects of ballistic vest use were included. Discussion: Although the effectiveness of ballistic vests is well established, prolonged use is frequently associated with discomfort, lower back pain, fatigue, and an increased prevalence of musculoskeletal injuries, particularly in the lumbar region and shoulders. Factors such as age, body mass index (BMI), and type of duty performed can negatively influence adherence to vest use. Mobility limitations, poor fit to body contours (especially in women), and outdated anthropometric data represent critical challenges that can compromise comfort, ballistic effectiveness, and operational performance. Body composition also directly affects performance under load, and targeted physical training programs may help mitigate the negative effects associated with personal protective equipment (PPE). Conclusion: Despite their proven effectiveness, ballistic vests require improvements in design and ergonomics to enhance comfort and safety. Updating anthropometric data, implementing public policies to promote consistent use, fostering awareness initiatives, and establishing specific physical training programs are necessary to ensure the health, protection, and quality of life of police officers.
Copyright (c) 2025 Karen Faria Coracini, Paulo Sérgio Tieppo Alves https://creativecommons.org/licenses/by/4.0
Economic and human impact of late diagnosis of oral cancer inBrazil’s Unified Health System (SUS)
Oral cancer in Brazil's Unified Health System (SUS) represents a major challenge, with 60% of cases diagnosed at late stages, increasing treatment costs by 500% from stage I (R$ 5,100) to stage IV (R$ 25,600) and reducing 5-year survival from 80% to 20%. This study reviewed 21 international studies and SUS data (2019-2024), identifying three critical factors: (1) barriers to early detection, with only 35% of primary care units conducting active screening; (2) regional disparities, such as a 120-day average diagnostic delay in the North versus 45 days in the Southeast; and (3) structural gaps in the healthcare network, with only 20% of units having trained dentists. Successful initiatives like the Boca Saudável (“Healthy Mouth”) Program (state of Rio Grande do Sul) demonstrate that professional training and fast-track referral protocols can reduce diagnostic time by up to 40%. Evidence-based strategies, including teledentistry for remote regions, targeted risk-group campaigns (smokers and older adults), and strict enforcement of legal treatment deadlines are urgently needed to reverse this scenario. A multisectoral commitment to early diagnosis is essential to improve outcomes and optimize SUS resources.
Copyright (c) 2025 Gabriel Dalpozzo Bortoli https://creativecommons.org/licenses/by/4.0
Assisted death in the light of Spiritism: a bioethical analysis of the spiritist doctrine on the end of life
In light of the Spiritism doctrine, assisted death – in the forms of euthanasia or assisted suicide – constitutes a premature interruption of the natural course of corporeal existence, interfering with the divine mechanisms that govern the moral and spiritual progress of human beings. Based on Allan Kardec’s teachings, Spiritism understands life as a divine loan granted for the improvement of the spirit, with suffering serving as an educational and expiatory tool in the individual evolutionary process. Amid the tensions between secular bioethical principles – especially autonomy – and spiritual responsibility, dialogue between traditional bioethics and an expanded bioethics that includes transcendence as a legitimate dimension of human experience is essential. Spiritism proposes an ethical and compassionate model of care, grounded in integrative palliative care, spiritual listening, and respect for the journey of the spirit, promoting a conscious and spiritually meaningful death.
Copyright (c) 2025 Otavio de Marco Dala Rosa, Rosana de Fátima Possobon https://creativecommons.org/licenses/by/4.0
Civil liability of laboratories for erroneous results
This study aims to analyze the legal complexity surrounding the civil liability of clinical laboratories in cases involving erroneous test results. An observational, cross-sectional, and descriptive methodology was employed, with data collected from the public databases of the Courts of Justice of São Paulo and Rio Grande do Sul, without time restrictions, in search of judicial decisions related to laboratory liability for errors in tests. A total of 33 relevant rulings were selected. The analysis revealed a higher incidence of claims related to HIV and gestational syphilis testing, with decisions predominantly favoring consumers, particularly in cases involving moral damages. The literature review highlighted the absence of a clear legal structure governing laboratory liability, despite the extensive scientific literature addressing the technical limitations of diagnostic tests. Civil liability was found not to arise solely from the erroneous result but from the breach of technical and scientific duties, underscoring the need for a thorough assessment of both causality and laboratory conduct. The analyzed case law tends to treat the obligation of laboratories as one of result, although judicial decisions may relativize liability considering the beneficial effects of early diagnosis. The study concludes that the civil liability of laboratories is predominantly objective and contractual, requiring proof of wrongful conduct, causal nexus, and damage for the claim of compensation, contributing to the improvement of legal understanding and protection of patients’ rights.
Copyright (c) 2025 Otavio de Marco Dala Rosa https://creativecommons.org/licenses/by/4.0
Analysis of the adequacy of medical expert reports in civil cases in light of the criteria established by the new Brazilian Code of Civil Procedure
Introduction: Medical expert reports are regarded as one of the most compelling forms of proof in judicial proceedings due to their technical and scientific nature. They are prepared by specialists appointed by the court to assist in resolving legal disputes. Until 2015, there were no specific regulations regarding the required format of such reports, a gap that was addressed with the enactment of the new Brazilian Code of Civil Procedure (CPC), which aimed to make the judiciary more efficient and accessible to all. Objective: To assess the technical adequacy of expert reports in cases adjudicated by the 1st and 2nd Civil Courts of Mogi das Cruzes, in accordance with the criteria established by the new CPC. Method: Eligible expert reports were identified on the e-SAJ website and subsequently analyzed for compliance with the prescribed standards. Results: All reports were found to be partially or entirely non-compliant with the recommended guidelines. Discussion: The absence of a clear statement of purpose, specification of the methods employed, substantiated technical and scientific analysis with the appropriate use of sources and references, and provision of conclusive and specific answers compromise the quality and reliability of the reports. These shortcomings undermine a fair and accessible justice system that upholds the rights to a full defense and due process through adversarial proceedings. Conclusion: A decade after the enactment of the new CPC, expert practice has not yet fully adapted to its established criteria. Recognizing the expert report as a cornerstone of judicial decisions is crucial to ensure that such decisions are grounded in solid evidence and scientific rigor, thereby reflecting the commitment of medicine to justice and ethics.
Copyright (c) 2025 Elisa Ferreira Vander Velden, Emílio Zuolo Ferro, Marcia Vieira da Motta https://creativecommons.org/licenses/by/4.0
Defensive medicine: from courts to medical practice – analyzing causes, costs, and solutions
Introduction: Defensive medicine refers to practices adopted to minimize the legal risks faced by physicians, which can negatively impact both patients and healthcare services. It is associated with the increasing judicialization of medicine and the structure of healthcare systems, leading to high costs, inefficiency, reduced productivity, resource waste, and limited access to care. Examining its causes has led to actionable solutions, including legal adjustments, reorganization of physicians’ workload, and improvements in medical education and ongoing training. The topic is closely connected to legal medicine, health economics, and preventive medicine. Objective: To analyze the determinants of defensive medicine in different healthcare systems, highlighting its financial and non-financial impacts, mitigation strategies, and the controversies documented in the scientific literature. Method: A search was conducted in the PubMed database using the Advanced Search Builder, including the following MeSH Terms in an additive manner: malpractice[MeSH Terms], AND, defensive medicine[MeSH Terms], AND, health care costs[MeSH Terms]. The search was filtered to include articles between 2016 and 2023, followed by a structured review of the selected articles. Results: Only original articles written in English were included. The six selected articles addressed the central theme of the present study. None of the articles were published in Latin America or referred to countries in this region. Conclusion: Defensive medical practices have expanded in tandem with the increasing judicialization of healthcare, affecting the quality of care and access to services and generating significant repercussions on the structure of healthcare systems, including substantial financial costs. The topic is especially relevant for legal medicine practitioners, jurists, healthcare managers, and policymakers, given its potential to modify structural variables and impact the long-term viability of healthcare systems.
Health Care Quality, Access, and Evaluation
Copyright (c) 2024 Thiago dos Santos Oliveira, Henrique Barretti Geaquinto, Emilio Zuolo Ferro https://creativecommons.org/licenses/by/4.0
Fatigue and its impact on morbidity and mortality among professional drivers: a narrative review
Introduction: Road transport is the most widely used mode in Brazil, and the road freight sector ranks among the highest nationally in work-related illnesses, accidents, disability retirements, and deaths. Fatigue is a complex symptom involving cognitive and emotional changes, with a multifactorial etiology ranging from organic to psychological causes, including sleep disorders. Objectives: To examine the association between fatigue and accidents involving professional drivers. Methods: A literature review was conducted using the Cochrane Library, LILACS, PubMed, and SciELO databases, applying health descriptors (DeCS/MeSH) and the Boolean operators "AND" and "OR". Articles published in Portuguese or English between 2013 and 2023 were included. Results: Of the 112 articles retrieved, 14 were selected. Total driving time was the most frequently reported risk factor for traffic accidents (42%), followed by shorter professional experience (28%). Additionally, male sex, psychological stress, organic conditions, and sleep disorders were identified as risk factors in 21% of the studies. Investment in training, particularly in safe driving practices, was the main factor associated with reduced risk of work-related accidents among professional drivers, being addressed in 57% of the selected studies. Conclusion: The literature consistently identifies fatigue as a key determinant of illness, adverse health outcomes, disability, and death among professional drivers.
Copyright (c) 2024 Athina Braga Soares SIlva, Gabriela de Arantes Silva, João Silvestre Silva-Junior, Marcelo Pustiglione https://creativecommons.org/licenses/by/4.0
The impact of occupational activity on cardiovascular diseases: a literature review
Introduction: Cardiovascular diseases (CVDs) represent a major global public health concern, accounting for substantial morbidity, mortality, and healthcare costs worldwide. Occupational activity plays a significant role in the development and progression of CVDs. Although numerous studies have examined work as a contributing factor, relatively few have synthesized work-related cardiovascular risk factors within a single review. Objective: To identify and discuss work-related risk factors associated with the development or exacerbation of cardiovascular diseases. Method: A literature review was conducted using the PUBMED database, including 65 studies. Results: Multiple work-related factors associated with an increased risk of cardiovascular diseases were identified. The reviewed studies also described pathophysiological mechanisms underlying disease processes triggered by these occupational exposures. Key risk factors included occupational stress, shift and night work, work-related lifestyle habits (such as diet and smoking), and high-pressure occupations, among others. Conclusion: While work is essential from a socioeconomic standpoint, it also constitutes a significant contributor to cardiovascular disease burden. Interventions such as workplace wellness programs, more flexible work schedules, and the promotion of healthy lifestyle habits are critical to mitigating the impact of CVDs among workers.
Copyright (c) 2025 Guilherme Barduchi Pio Marchesi https://creativecommons.org/licenses/by/4.0
Touch DNA Analysis in Forensics: advantages and limitations
Advances in Forensic Genetics have enabled the analysis of samples with low DNA quality and quantity, allowing the generation of genetic profiles based on autosomal STR markers. Among such samples is touch DNA, which refers to genetic material deposited through contact with a surface or object. Its analysis is particularly valuable when fingerprints have low integrity or insufficient detail for examination through papilloscopy. Touch DNA transfer can occur through direct contact between the depositor and a surface (primary transfer) or via an intermediate vector (secondary transfer). Secondary transfer often results in mixed DNA profiles from multiple individuals, complicating interpretation. Several factors influence touch DNA deposition, including shedder status, an inter-individual variation affected by age, sex, skin conditions, and personal habits. In addition, variables such as surface type, time elapsed since hand hygiene, and the nature of contact also impact DNA deposition and recovery. The deposited DNA may originate from skin cells on the hands or from genetic material transferred from other body regions, including bodily fluids such as sebum and saliva. Research in this field underscores the need to better understand the variables affecting touch DNA deposition and recovery to enhance forensic practices and improve the interpretation of genetic profiles in criminal investigations.
Copyright (c) 2024 Juliany Barreto Kisberi, Cintia Fridman https://creativecommons.org/licenses/by/4.0
Influence of the COVID-19 pandemic on intentional homicides in the city of São Paulo
The World Health Organization declared in January 2020 that the outbreak of the disease caused by the new coronavirus, COVID-19, constituted a public health emergency of international concern. In March 2020, it was classified as a pandemic, leading to changes in people's daily lives. Fear of the disease and social isolation culminated in unemployment, increased alcohol consumption, and emotional problems, among other effects. This study aimed to analyze the influence of the pandemic on homicides in the city of São Paulo. An ecological study was carried out at the Department of Legal Medicine, Bioethics, Occupational Medicine, and Physical and Rehabilitation Medicine of the School of Medicine of the University of São Paulo. Data were obtained from the São Paulo Department of Public Security website (http://www.ssp.sp.gov.br) for the years 2019 (pre-pandemic) to 2022 (post-pandemic). Data analysis was performed using SPSS® Version 27.0. The epidemiological analysis employed the Poisson test to examine monthly homicide occurrences, complemented by cross-sectional and longitudinal analytical methods to compare homicide incidence rates across the city’s different zones. In the annual comparison of 2019 (5.95 deaths/100 thousand inhabitants) with 2020 (5.75 deaths/100,000 inhabitants), 2021 (4.95 deaths/100,000inhabitants) and 2022 (4.93 deaths/100,000 inhabitants), with a p-value of 0.001, there was a statistically significant difference in the mean number of cases across the studied periods. This finding was corroborated by analytical approaches using longitudinal and cross-sectional analyses. When analyzing homicides across the five municipal zones, the 2019 pre-pandemic period showed significantly higher rates compared to subsequent years. Homicides decreased during the pandemic period compared to the previous year. This drop in intentional deaths may be associated to social isolation measures implemented during the study period.
Copyright (c) 2024 Danilo Ramos, Carmen Silvia Molleis Galego Miziara, Ivan Dieb Miziara https://creativecommons.org/licenses/by/4.0
Medical confidentiality: the medical professional’s view at the different stages of professional training
Introduction: The doctor-patient relationship is built on mutual trust. Information obtained during medical consultations must be kept confidential, in accordance with ethical and legal principles. However, under certain circumstances, breaching confidentiality may be required, without constituting an ethical or legal violation. In fact, in such situations, the breach is mandatory. It is crucial that medical students receive training in the deontological and legal norms related to this topic during their undergraduate studies. Objectives: This study aimed to evaluate the level of knowledge of both medical students and practicing physicians in decision-making in hypothetical clinical cases involving the breach of medical confidentiality. Method: This is a cross-sectional, descriptive study with a quantitative approach. Informed consent was obtained from all participants before they completed a self-administered questionnaire, which was hoasted on an online platform. The questionnaire was divided into two sections: the first containing sociodemographic questions and inquiries regarding the participants’ stage of professional training and the second presenting ten hypothetical clinical cases in which participants were asked to decide whether medical confidentiality should be breached. The relationship between sociodemographic characteristics and the participants' stage of training was analyzed using the chi-square test, with a 95% confidence level. Results: After applying exclusion criteria, a total of 87 participants were included in the analysis. Of these, 18 were undergraduate medical students and 69 practicing physicians. No statistical significance was found when comparing different stages of professional training with the variables studied in this sample. Discussion: The findings revealed a lack of knowledge among both students and physicians regarding the ethical and legal determinants that govern breaches of confidentiality. Conclusion: Medical deontology should be integrated into the medical curriculum throughout the six years of undergraduate education.
Copyright (c) 2024 Emílio Zuolo Ferro, Ivan Dieb Miziara, Carmen Silvia Molleis Galego Miziara https://creativecommons.org/licenses/by/4.0
Uterine Surrogacy: Legal Questions Under Contract Law
This article examines the legal framework surrounding uterine surrogacy from a contract law perspective, focusing on doctrinal concepts, laws, and relevant resolutions. The right to procreate has benefited from the development of medical techniques, allowing individuals deemed infertile to have their own biological children. Among the options provided by science is uterine surrogacy, which involves the participation of a third party in the reproductive process. This arrangement raises several legal issues, particularly regarding disputes over maternity. This article addresses the following question: under Brazilian law, is it possible to draft a uterine surrogacy contract involving a surrogate who is not related to the intended parents? The primary objective is to explore the legality and implications of such a contract in the context of uterine surrogacy. Specific objectives include defining assisted reproduction, especially surrogacy, and discussing the legal ramifications of this practice. Furthermore, the article analyzes the application of Resolution No. 2,294/2021 of the Federal Council of Medicine (CFM), pointing out the main divergences in its practical application. Finally, the article aims to examine the legal relationship between the surrogate and the intended parents, considering the possibility of applying contract law provisions. The methodology used is bibliographic and documentary research, employing an exploratory approach. This study is justified by the lack of specific legislation on the subject and aims to expand knowledge on an issue that remains underexplored, both in academic or social contexts, emphasizing the need for legal safeguards for those who opt for this method.
Copyright (c) 2024 Camila Sampaio Ribeiro https://creativecommons.org/licenses/by/4.0
Mask-related acne during the Covid-19 pandemic
The lessons from the recent pandemic should be given due consideration and used as fundamental tools to conduct new research aimed at minimizing the major adverse effects of inappropriate use of standard protective measures by patients and healthcare professionals. This manuscript specifically addresses the first occurrence or worsening of acne associated with daily use of facial masks for very prolonged periods. The authors of the additional comments on the latest literature data hope to highlight timely topics on "mask acne" published in the latest edition of this Journal.
Copyright (c) 2024 Kin Modesto Sugai, Vitorino Modesto dos Santos https://creativecommons.org/licenses/by/4.0
Rights of pregnant, adopting, and breastfeeding workers in Brazil: applied legislation
Due to its complexity, the Brazilian legislation requires continuous study from legal practitioners to ensure proper application. The protective rules for maternity, including pregnancy, adoption, and lactation have gradually been increased over the years, in compliance with Article 7 of the Brazilian Constitution, which encourages the emergence of new social rights. These rights can be stratified into those that arise with pregnancy, those that develop during the course of gestation, and those that protect the child at the beginning of its life outside the womb. Additionally, there are rights pertinent to new situations or aimed at increasing the father’s participation during this initial phase.
Copyright (c) 2024 Alvaro Emanuel de Oliveira Simões, João Silvestre Silva-Júnior https://creativecommons.org/licenses/by/4.0
Copyright (c) 2023 Daniel Romero Muñoz http://creativecommons.org/licenses/by/4.0
Preserve them in museums when of scientific interest: the human remains collection in the trajectory of the Scientific Technical Museum of the Oscar Freire Institute (MTCIOF)
This article draws on historical literature on forensic medicine, the musealization of human remains, and institutional documentation to elucidate the role of the Scientific Technical Museum of the Oscar Freire Institute as a pedagogical resource in shaping the medical-legal specialty in São Paulo during the 20th century. By tracing the institutional trajectory of the museum alongside the history of Forensic Medicine at the institute, it prompts reflection on the ethical implications of housing human remains in museum collections. To effectively preserve, recover, research and display this collection, a comprehensive understanding of its material culture is crucial. The article underscores the ethical imperative of crafting a museum narrative capable of sensitively addressing themes while ensuring the dignity of the people represented by these remnants. Historical context and conservation efforts are therefore essential components of this endeavor. Ultimately, by developing historically informed biographies of musealized human remains, we can strive to safeguard both their material integrity and their dignity.
Copyright (c) 2023 Jose Guilherme Veras Closs http://creativecommons.org/licenses/by/4.0
Brief history of the bureaucracy and the space administration of the Oscar Freire Institute (1923-1938)
This article uses historiographical references and institutional documentation to observe the history of the Oscar Freire Institute of Legal Medicine (IOF) as the fabrication of a social space and an specialized bureaucracy, among regulations, positions, laws and hierarchies, during the years of 1923 to 1938. To this end, two interconnected historical processes are overviewed and exposed in two separate topics during the article: the first relating to the assembly of the legal and administrative entity of the IOF and the second focused on the production of the institution's physical space. Both topics demonstrate the organization of a network of texts and agents that contributed to the institutionalization of the Legal Medicine in São Paulo and determined the position of dominance of the institute as an administrative machinery, specialized in forensic practice and teaching. Along this path, it becomes clear how intra and inter-institutional mechanisms became entangled in the configuration of the IOF in São Paulo, both inseparable from the historical context of disputes and negotiations surrounding Forensic Medicine institutionalization.
Copyright (c) 2023 João Denardi Machado http://creativecommons.org/licenses/by/4.0
André Hellegers, the emergence of Bioethics and the Kennedy Institute of Ethics
The dual origin of Bioethics in 1971, with the publication of Potter's book “Bioethics: bridge to the future” and the creation of the Kennedy Institute by André Hellegers, is constantly cited in the literature. Potter's concept of Bioethics is described as broad and linked to an ecological vision, while Hellegers' notion is focused solely on health issues, representing an expanded form of medical ethics. The objective of this study was to explore and analyze the life and work of André Hellegers. Hellegers was a Catholic medical scientist, engaged with the ethical and human challenges of his time, marked by significant social, cultural and medical changes. He sought to address the ethical dilemmas in healthcare with a medical, scientific and ethical approach. Rather than solely contributing to the theoretical field of Bioethics, he aimed to address the practical ethical dilemmas faced by physicians, patients and their families. Alongside this pragmatic approach, he drew upon the insights of prominent thinkers in Theology and Philosophy, as well physicians concerned with the humanistic aspects of medicine, to develop and refine his own bioethical framework, thereby fostering conditions for research, education and dissemination of the major themes in Bioethics.
Copyright (c) 2024 Trajano Sardenberg, Valdir Gonzalez Paixão Junior, Gilberto José Cação Pereira, Emilio Carlos Curcelli, Mauro dos Santos Volpi, Paulo Roberto de Almeida Silvares, Reinaldo Ayer de Oliveira https://creativecommons.org/licenses/by/4.0
Ethical and deontological knowledge of medical students about organ and tissue donation in Brazil
Organ donation and transplantation have been taking place in Brazil for decades, acting as an effective alternative for individuals who do not benefit from conventional treatments. This requires a regulatory framework that allows for organ removal while respecting bioethical and legal standards. This study aims to assess the knowledge of future health professionals regarding the ethical and deontological issues involved in organ and tissue donation. This descriptive and qualitative study was carried out with medical students from the first to the fifth year at a university in the west of the state of Paraná, Brazil, with a sample of 131 participants. The results showed 84.7% of students had never attended classes on the subject during their undergraduate years. Despite this lack of formal education, 53.4% correctly identified the concept of brain death. Additionally, 94.7% expressed willingness to donate their organs and 31% believed certain groups should be excluded from the transplant list. The findings suggest a gap in university curricula regarding the subject, yet students are actively seeking alternative ways to gain knowledge. Moreover, there was a high acceptance rate among students for post-mortem organ donation. Opinions diverged significantly on ethical and individual issues such as the exclusion of people from the transplant list.
Copyright (c) 2024 Millena Delazeri Bastos, Bruna Caroline Lancini, Carlos Frederico de Almeida Rodrigues https://creativecommons.org/licenses/by/4.0
Where did that dental bur go? Patient Safety Lessons from a Dental Teaching Hospital
Introduction: Ingested or aspirated dental burs have been reported in the literature. These events are akin to medical errors that can potentially cause patient morbidity or mortality and must be examined in the larger context of maintaining patient safety in dental settings. Case report: This work presents a case of an ingested bur and a near-miss event of a bur detached from a high-speed dental handpiece. Both cases occurred during the management of patients by students in a dental school setting. Conclusion: These cases are presented through the lens of patient safety. Conclusions are made on how organizational policies and curricula change can prevent such errors in the dental clinical training environment and mitigate patient morbidity or mortality.
Copyright (c) 2024 Shivaughn Marchan https://creativecommons.org/licenses/by/4.0
Oscar Freire: the inventor of Legal Medicine in Brazil
This article delves into the remarkable legacy of Oscar Freire, tracing his pivotal role as a pioneer in the field of Forensic Medicine in Brazil and arguing that he introduced scientific teaching in this field in the country. Born in Bahia and mentored by Nina Rodrigues, Freire became the first full professor of Forensic Medicine at the School of Medicine of the University of São Paulo. He conducted groundbreaking studies using the Brazilian population as a basis and catalogued the nation’s cadaveric fauna. In the field of medical education, he instituted the first course on Medical Deontology within the regular medical curriculum. He also established the first specialization course in Forensic Medicine, while still in Bahia. Finally, he established a school of Forensic Medicine in São Paulo.
Copyright (c) 2023 Ivan Dieb Miziara http://creativecommons.org/licenses/by/4.0
The scientific production of the Oscar Freire Institute amid the technical formalization of Legal Medicine in São Paulo: theses, texts, agents (1923-1938)
This article proposes a historical reading of scientific texts from the 1920s and 1930s to understand the process of technical formalization of Legal Medicine in São Paulo, focusing on the academic production of the Oscar Freire Institute (IOF) of São Paulo Medical School (FMC-SP). Four doctoral theses produced at the IOF are mentioned, in order to cover different sectors of Legal Medicine and understand formal, conceptual and bibliographical parameters that permeated the Institute’s scientific production between 1923 and 1938. The analysis indicates how the scientific texts from the IOF contributed to the appropriation of a set of tools, objectives, and concepts proper to a new kind of legal medical specialist, fully recognizable at the end of the 1930s. The standards of research and practice adopted within the IOF helped to end the volatility of the field as a science-in-the-making and established Legal Medicine as a ready-made science in São Paulo, according to an eclectic and pragmatic model within the medical field.