Dirce Bellezi Guilhem

Background: Health judicialization intensified during the COVID-19 pandemic in Brazil, placing courts at the centre of disputes over resource allocation, access to treatment, vaccination mandates, and intergovernmental health governance. Although bioethical frameworks for pandemic decision-making are abundant, they are primarily directed at administrators and clinicians. Guidance tailored to judges’ institutional role and to the specific conditions of a declared public health emergency remains underdeveloped. This study addresses that gap. Methods: This empirical bioethics study was conducted in two integrated stages. Stage 1 comprised a qualitative documentary analysis of Brazilian judicial decisions concerning COVID-19 health litigation, retrieved from the AASP/JUIT case-law database. The decisions are primary public sources, identified by case number and reproduced in full in Additional file 1. The search identified 17,537 cases from 2019 to 2025. Systematic probabilistic sampling (k = 18) yielded 1,002 decisions, of which 417 were excluded during eligibility screening, leaving a final corpus of 585 decisions distributed across four mutually exclusive thematic axes. Stage 2 used wide reflective equilibrium to integrate the empirical patterns with three theoretical traditions: principlist bioethics, Latin American social bioethics, and public health ethics benchmarks. An audit trail linked each empirical finding to the bioethical tension identified, the candidate parameters generated by each tradition, the points of divergence, and the final adjudicated parameter. Results: The corpus comprised 223 decisions on ICU access and resource scarcity (38.1%), 171 on compulsory vaccination and individual autonomy (29.2%), 122 on medication provision (20.9%), and 69 on federative conflicts and SUS governance (11.8%). We propose the Bioethical Matrix for Judicial Orientation in Sanitary Emergencies (BMJOSE), which comprises four sets of axis-specific parameters and five cross-cutting principles: proportionality, equity of access, evidence-based reasoning, institutional transparency, and protection of the minimum existential core. The derivation is presented in full for Axis I. The framework is then applied to three decisions from the corpus: one in which it confirms and enriches the reasoning, one in which an existing binding precedent already embodies the relevant parameter, and one in which it would have required different reasoning. Conclusions: BMJOSE is offered as a reasoning scaffold, not as a source of authority that supersedes law, precedent, or judicial ethics. It operates within duties already imposed on judges by Brazilian law, particularly articles 20 and 21 of the Law of Introduction to the Norms of Brazilian Law, as amended in 2018, and gives those duties emergency-specific, axis-based content. Its contribution lies in structuring judicial reasoning and making it auditable, rather than in creating new principles.

The study investigated the relationship between occurrence of damage and destruction of public health facilities and losses due to disasters, health care expenditure, the indicators of disaster risk management in Brazilian municipalities in the period from 2013 to 2020. The method was secondary data analyses using national datasets in the public domain. Only records of disasters recognised by the Federal Government were selected. In total, 19,026 records of disasters and their impacts were analysed, including 949 Brazilian municipalities. The results showed that as the number of dead, injured, and ill people grows, the number of damaged health facilities also tends to increase for all years. However, the correlation coefficient was weak, except for the years 2013, 2014 and 2015, which was moderate. The spatial distribution of municipalities with the highest disaster-related expenditures is concentrated in the states of Amazonas, Pará, Acre, Mato Grosso do Sul, and in some states in the Northeast. Hydrological (flooding and flash floods) have caused the most damage and destruction of health services. The indicators of disaster risk management do not explain the variation in the occurrence of damaged or destroyed facilities, because the coefficient values indicated a very weak correlation.

Resumo No SUS, a participação social é um princípio fundamental. Com a Lei 8.142, de 1990, essa participação foi instituída por meio dos conselhos e das conferências de saúde, mas esses não são os únicos meios de a sociedade participar da gestão do SUS. Objetivou-se identificar formas de participação social no SUS e quais são os desafios e potencialidades desse princípio. Trata-se de uma revisão de escopo com a pergunta de pesquisa: quais as formas de participação dos usuários na gestão do SUS? Pesquisa realizada em português, inglês e espanhol nas bases de dados PubMed, BVS, Scopus, Embase e Web of Science. Quarenta e seis artigos foram selecionados para leitura na íntegra e análise, com sete categorias de participação da comunidade no SUS: conselhos de saúde, pesquisa de avaliação do serviço pelo usuário, educação popular em saúde, movimentos sociais ligados à saúde, consulta pública, conferências de saúde, ouvidorias. Os sete mecanismos de participação social no SUS formam um mapeamento a partir do qual é possível pensar formas de superar as barreiras de cada um dos mecanismos e como fortalecê-los. Também possibilita a reflexão sobre a reinvenção e criação de novos modelos de participação.

To describe a pedagogical experience with nursing students who used photographs as a teaching tool for teaching human rights. This is a report of a pedagogical experience of a cross-sectional qualitative study based on narrative bioethics, which uses personal narratives as an analytical instrument to deepen the understanding of ethical problems, and on iconographic analysis, which investigates the deep meanings and contexts underlying the recorded photographs. The photographs taken by "photographer students" portray real situations from everyday life in our society, highlighting issues such as poverty, social exclusion and government negligence, which, according to the participants themselves, evoke violations of several articles of the Universal Declaration of Human Rights. The pedagogical workshop used photography to engage students in reflections on human rights and social issues, promoting ethical and humanized training. Despite limitations, the study revealed a deficit in university education on human rights, but highlighted the potential of innovative methodologies to strengthen the critical and empathetic preparation of future professionals.

Objetivo: Avaliar o conhecimento dos profissionais de enfermagem acerca da imunização em pacientes com tumores sólidos. Método: Estudo exploratório e descritivo, com abordagem quantitativa, realizado em um hospital público do Distrito Federal. Participaram 31 profissionais de enfermagem, que responderam a um questionário autoaplicável composto por 11 questões relacionadas à imunização em oncologia. Foi calculado um escore de conhecimento, classificando os participantes em níveis inadequado (80%). Resultados: A maioria dos participantes (58,1%) apresentou conhecimento inadequado, 32,3% parcialmente adequado e apenas 9,7% adequado. Foram identificadas lacunas em temas como indicações de vacinas inativadas (77,41% mencionaram), contraindicações de vacinas atenuadas (32,25% citaram corretamente) e conhecimento sobre doenças imunopreveníveis de alta morbimortalidade. Conclusão: Os resultados evidenciaram conhecimento insuficiente sobre imunização em oncologia entre os profissionais de enfermagem avaliados. Recomenda-se a implementação de programas educativos, a elaboração de protocolos institucionais e o fortalecimento da educação permanente, visando à melhoria da qualidade da assistência e à segurança imunológica dos pacientes oncológicos.

Prezados(as) editores(as), no artigo “Perspectivas para las políticas públicas de atención primaria en salud en Suramérica”¹, com o objetivo de analisar a implementação da atenção primária à saúde (APS) em nove países da América do Sul, foram apontadas brilhantemente três dimensões estruturantes da APS. Na dimensão “(2) Modelo de Atenção”, embora as seis categorias selecionadas sejam de extrema importância para avaliação de como está estabelecida a APS nos países latino americanos, é preciso considerar o quão valioso seria incluir a vigilância em saúde como parâmetro de implementação da APS.

This article presents a critical analysis of the impact of artificial intelligence on education, emphasizing its capacity to optimize processes by personalizing experiences and data processing in real time. Additionally, the relation between artificial intelligence and the “Pygmalion effect” was considered, a phenomenon by which expectations influence student performance. Considering that this technological tool, by providing personalized feedback in real time, can inform these expectations, influencing academic performance and student-teacher interaction, reflections on its use are made by raising ethical challenges such as privacy, algorithmic biases, and unequal access to technology, which can increase existing gaps. The importance of training for use of artificial intelligence and the need for an ethical approach to avoid inequalities and discrimination are stressed.