2017 EACME Annual Conference “Justice in Health Care – Values in Conflict” September 7-9, 2017 Barcelona CONFERENCE BOOK ii Welcome to Barcelona Both the European Association of Centres of Medical Ethics (EACME) and the Borja Institute of Bioethics-Ramon Llull University (Barcelona) organize the 2017 EACME Annual Conference. The European Association of Centres of Medical Ethics (EACME) is, since its creation in December 1986, an international research and communication network with the aim to promote research, education and consultation in the field of (bio)- medical ethics. The Borja Institute of Bioethics-Ramon Llull University (Barcelona) was founded in 1976 with the main goal of studying in depth the problems raised by progress in biomedical science and its implications for society and its values, disseminating its findings in specialized publications. Recent developments in several countries in Europe, such as austerity measures, lead to concerns about the conflict between justice in health care with other eco- nomic and political values. That is why the Programme of 2017 EACME Annual Conference, under the topic \Justice in Health Care { Values in Conflict”, focuses on the following important issues: • Determinants of Health { What does health mean? Looking beyond WHO definition { Lifestyles and health { Quality of life { Social expectations and medicalisation of life { Salutogenesis and health-promotion activities • Healthcare Systems: at the Service of What? { Ethical issues in different models of Healthcare Systems { Sustainability { The role of Primary Care in health systems { Ethics issues in research with big data { Designing future healthcare systems • Justice and Vulnerability { Social inequalities in health { Mental health care { Care for people with disability { Childcare, Elderly care { End-of-life care iii • The Role of Professionals and Research { Professionalism and decision-making { Effects of austerity measures on health care { Quaternary prevention { The clinician as a manager of resources { Continued education { Responsibility and integrity in research We are wishing to discuss about all these important questions with you. Welcome to Barcelona! Margarita Bofarull Bu~nuel President of the Scientific Committee Montserrat Esquerda Arest´e President of the Organizing Committee iv The Borja Institute of Bioethics The Borja Institute of Bioethics started in 1976 with Dr Francesc Abel, S.J., doctor in Medicine and Surgery, specialist in Obstetrics and Gynaecology, and masters degree in both Philosophy and Theology. Dr Abel started his investigation in the United States of America at the precise time when Bioethics became a discipline. When he came back to Europe he had the immediate and lucid insight to create the first Bioethics institute in the Old Continent, task in which he was backed by the Society of Jesus, and later by the Hospitaller Order of Saint John of God. In 2000, the centre was incorporated into the Universitat Ramon Llull as a university institute. The Borja Institute of Bioethics main aim is to study in depth problems raised by progress in biomedical science and its implications for society and its values. In addition, the Institute encourages interdisciplinary dialogue between scientists and humanists as a means to integrating scientific knowledge and ethical sensibility and finding appropriate ways to solve the problems arising from conflicts between technical views of reality and the cultural and social values which are essential in any discussion of human rights. The human team of the Institute is formed by professionals of different disciplines and expertise, from the Medicine, Philosophy, Theology, Law and Social Science. Most part of the Borja's team share the bioethics dedication with its own professional scope. The main activities of the institute are education, research and assessment in bioethics. Education The Institute offers a University Master's degree in bioethics (12 edition) that aims to promote reflection and research on ethical issues related to human life and the value conflicts often generated by advances in medical science and technology. Progress in genetics, the beginning of life, health care priorities, patient rights, pub- lic health, organ transplants, AIDS, degenerative diseases or disabilities, the limits of treatment, or end-of-life decisions, are just some of the issues it addresses. These studies aim to provide professionals with a solid training required to be able to identify and clarify the main problems raised by human life and health care from an ethical standpoint. Professors representing a variety of disciplines | philosophy, human rights, health sciences and law| will provide both theoretical and practical guidance. Also, two Courses of University Experts are offered by v the Institute: an University Expert Course based in Clinical Ethics and another University Expert Course in Social Ethics. And we also offer a basic bioethics training, an Intensive Course on Ethics and good Clinical Practices, and Up-date or monographic courses. Research The Borja Institute Research activity is organized around four main lines: 1. Ethical criteria for the distribution of resources: rethinking Public Health Sys- tems. In Western countries, the demand for health services is growing at a faster rate than the available resources. Chronic disease, population age, biotechnological development, social changes, the risk of over diagnosis and overtreatment are some of the issues. 2. Moral development, empathy and burnout in medical and health students and health professionals. The physician's and health professionals' ethical devel- opment plays an important role in quality healthcare, patient safety, and in patient's quality of life. The aim of this line is how health professionals and students develop ethical competence, and the relationship with empathy or burnout. 3. Health decision in children and adolescents. Assessment of the minor's compe- tence for decision-making in health and research. The participation of children and adolescents in healthcare processes is a new challenge. Not only does it require a change of attitudes towards minors but also acquiring knowledge and skills to be able to develop shared decision-making and information processes. In this context, it is therefore crucial to develop an assessment of the minor's competence that can be easily corrected and applied within the normal time frame of a clinical consultation. 4. Ethical aspects at the end of life. The Institute participates in a multi-centre project on end-of-life, as well as in some projects on training in attitudes about death and mourning, and fear of death. The Institute also publishes the journal Bioetica & Debat, and co-publishes the Revista Iberoamericana de Bio´etica and the Ramon Llull Journal of Applied Ethics. Assessment The Institute has been of big importance in the creation of the first Healthcare Ethics Committee (HEC) in Spain: the one at Hospital Sant Joan de D´euin Esplugues de Llobregat (Barcelona). It has also helped in the creation of other HEC and belongs to various HEC and Human Research Ethics Committees. vi After more than 40 years of existence, the Borja Institute of Bioethics continues being faithful to the idea of his founder, which means faithfulness to academic and scientific rigour, to the spirit of dialogue and compromise with society in accor- dance with our present time, with a scope of positivism towards the future. The search for academic formation, the results of investigation towards society, innova- tion and assessment, in cooperation with centres and institutes dealing with the field of Bioethics around the world, will define our way in years to come. vii viii Organization The 2017 EACME Annual Conference is organized by the European Association of Centres of Medical Ethics (EACME) and the Borja Institute of Bioethics-Ramon Llull University (Barcelona). Honorary Committee Mr Antoni Com´ıni Oliveres - Minister of Health of the Generalitat de Catalunya, Catalan Government Br Jos´eLu´ısFonseca Bravo - Superior Provincial of Arag´o-Sant Rafael Province of the Hospitaller Order of Saint John of God Dr Lloren¸cPuig i Puig - Delegate of Catalonia Territorial Platform of the Soci- ety of Jesus Dr Josep Maria Garrell i Guiu - Rector Magnificus of Ramon Llull University, Barcelona Dr Joan Planellas i Barnosell - Dean of the Faculty of Theology of Catalonia Dr Ruud ter Meulen - President of the European Association of Centres of Med- ical Ethics Dr Josep A. Bomb´ıi Latorre - President of the Royal Academy of Medicine of Catalonia Dr Vict`oriaCamps Cervera - Universitat Aut`onomade Barcelona Emeritus Pro- fessor of Moral Philosophy and Politics Dr Javier de la Torre D´ıaz - Director of the Chair in Bioethics of the Comillas Pontifical University Dr Juan Mar´ıade Velasco Gogenola - Assistant Professor of Theology of the University of Deusto Scientific Committee Margarita Bofarull (chair) - Borja Institute of Bioethics { Ramon Llull University Ester Busquets - Borja Institute of Bioethics { Ramon Llull University Juan Antonio Camacho - Borja Institute of Bioethics { Ramon Llull University Francisco J. Cambra - Borja Institute of Bioethics { Ramon Llull University Maria Casado - University of Barcelona Jordi Craven-Bartle - Borja Institute of Bioethics { Ramon Llull University Victoria Cus´ı - Borja Institute of Bioethics { Ramon Llull University Montserrat Esquerda - Borja Institute of Bioethics { Ramon Llull University ix Pau Ferrer - Borja Institute of Bioethics { Ramon Llull University