Salud Colectiva最新文献

Aging and increased life expectancy generate growing challenges for end-of-life care in old age, particularly in rural contexts marked by territorial and health inequalities. From the perspective of gerontological geography and the notions of autonomy and agency of older adults, this study aims to generate an understanding of end-of-life as a lived experience from the subjective worlds of and with the people involved. To this end, a qualitative study, with an ethnographic approach and case study strategy, was conducted in the Los Lagos Region of Chile between 2022 and 2023. This included semi-structured interviews and ethnographic observation of rural older adults in the end-of-life stages, their caregivers, and rural health teams. The results show that remaining at home is a central desire and organizes care, sustained primarily by feminized family networks and rural primary care. The home becomes a space of care, and health teams play a key role in providing clinical and relational support at the end-of-life. It is concluded that end-of-life care in rural areas requires territorial approaches that recognize autonomy in old age and the structural inequalities of these processes.

The Brazilian legislative debate on end-of-life practices involves ethical-axiological tensions related to euthanasia, assisted suicide, palliative care, and advance directives, in which divergent conceptions of these practices and of the value of life confront one another, influencing the normative formulation of the dying process. This study analyzes how such tensions are constructed and justified in the discourses of the Federal Legislative Branch, examining the normative meanings and the hierarchy of values attributed to the palliative care framework and to advance directives, as well as their ethical and moral implications. A qualitative documentary study was conducted, guided by a hermeneutic-dialectical approach and grounded in contemporary frameworks of the bioethics of responsibility and everyday bioethics. A total of 193 federal legislative documents (1981-2020) were examined. The analysis yielded two thematic categories: (1) the palliative care framework: meanings and attributions, which reveals the legislative tendency to limit the right to therapeutic refusal; and (2) instruments and mechanisms for the reversal of advance directives, which exposes restrictions on instruments intended to protect autonomy. The findings indicate the predominance of arguments grounded in vital values treated as absolute, to the detriment of personal values such as human dignity, autonomy, and self-determination, which may restrict the right to die with dignity in Brazil.

People diagnosed with schizophrenia exhibit low rates of labor market participation, a phenomenon that has been predominantly addressed from biomedical approaches that associate work inclusion with pharmacological stabilization. However, there is limited research examining how the everyday use of neuroleptics shapes the work experiences of those employed with this diagnosis. The aim of this study was to understand the role of neuroleptics - conceived as actants - in the experiences of workers diagnosed with schizophrenia in Chile and their implications for labor inclusion. A qualitative ethnographic study was conducted between 2022 and 2024 in the Metropolitan Region of Chile, including participant observation across diverse everyday and workplace settings, as well as 86 interviews (53 with workers diagnosed with schizophrenia and 33 with individuals from their close environment). Drawing on actor-network theory and the notion of enactment, the analysis identified that the diagnosis and the neuroleptic become assembled as a lifelong practice, configuring an experience marked by tensions. Although medications are valued for alleviating distress, their assemblage with diagnosis and their side effects - sedation, motor disturbances, salivation, weight gain, and affective flattening - mediate the body, the psyche, and social life, hindering work performance and exposing individuals to stigma and discrimination.

This article arises from the need to critically reflect on the subjective experience of those who request euthanasia, as well as on the ethical tensions between the conceptual clarity required by legal regulation and the specific, unquantifiable dimensions of human experience linked to suffering and fragility. In this sense, this essay seeks to contribute to current debates on the topic through the conceptual tools offered by moral philosophy, particularly Charles Taylor's analyses of the construction of the self and Paul Ricoeur's reflections on the notion of autonomy. Taking as a point of departure the draft bills presented in Argentina between 2021 and 2024 to regulate euthanasia and medically assisted suicide, we draw on the contributions of these authors to critically examine two issues we consider ethically and legally significant for such proposals: (1) existential suffering as grounds for requesting euthanasia, and (2) the intersection between autonomy and fragility as defining horizons of the subject of rights.

This essay critically examines the figure of the peer support worker within the mental health system of the Spanish State as a dispositif situated in the tension between the transformation of epistemic hierarchies and the risk of institutional co-optation. Drawing on our experiences and research in the field of critical medical anthropology and human rights in mental health, together with and from the activisms of the Mad Movement in the Spanish State, we analyse how this professional figure simultaneously embodies a promise of epistemic power redistribution and the danger of neutralisation by the hegemonic biomedical model. We argue that epistemic justice in mental health requires the radical transformation of the material, relational, and institutional conditions that have historically sustained the delegitimation of experiential knowledge. Through a genealogical analysis of the peer support worker and its processes of institutionalisation, we identify the structural conditions that determine whether its incorporation can effectively challenge dominant regimes of truth or, conversely, operates as a mechanism of legitimation that formally incorporates diversity without transforming existing logics of power. We conclude by proposing a framework of four dimensions of political intervention: strengthening epistemic fraternities and Mad Movement networks as community assets, transforming professional cultures, contesting regulatory frameworks, and articulating local processes of knowledge co-production.

How urban Chinese women understand and morally evaluate surrogacy remains an insufficiently explored area, despite the persistence of this practice in clandestine forms under a strict legal ban in China. From the perspective of moral sociology, this qualitative study foregrounds these overlooked voices through semi-structured interviews with 24 women in Nanjing, conducted between May and July 2025. The findings reveal a form of "pragmatic ambivalence": rather than holding binary positions of approval or rejection, participants articulate a nuanced and context-dependent stance. This stance is shaped by three key dimensions: (1) embodied reproductive experiences that heighten ethical sensitivity; (2) fertility pressures and practical reproductive needs that drive conditional support; and (3) legal prohibition and dominant moral norms that reinforce structural skepticism. We argue that women's attitudes do not constitute abstract choices, but are situated within the tension between bodily autonomy and familial obligation.

The rise in the population experiencing homelessness has become one of the defining social contradictions of our time. In Brazil, this increase persists even in the face of positive outcomes from economic and social assistance policies aimed at reducing poverty, underscoring the phenomenon's multicausal nature. The essay reconstructs the historicity of the dispositifs of normalization, governmentality, and counter-right, showing how bare life is actualized in territories where the state of exception operates as rule. Building on this foundation, it analyzes the multiple dimensions - economic, political, racial, security-related, and care-related - that converge in the growth of homelessness in Brazil, emphasizing the structural production of expropriation, precarization, and wounded subjectivities; while also highlighting the creative and political vitality of favelas and peripheral territories, the emergence of insurgent citizenships, and forms of territorial self-governance that challenge the neoliberal order. Finally, it proposes care, solidarity, and the commons as transformative horizons capable of reorienting the State toward a pedagogical and dialogical model grounded in radical democratization and in the reconstruction of social bonds based on justice, autonomy, and respect for human rights.

In an adult-centered and adultist culture, state interventions addressing violations of the rights of children and adolescents are grounded in a paternalistic view that limits their ability to exercise autonomy, despite international treaties that guarantee it. In Chile, there are protection and reintegration programs that intervene according to the needs identified at the family, community, and institutional levels, including health-related needs. This exploratory qualitative study analyzed 13 interviews with health professionals experienced in adolescent care, conducted in the Metropolitan Region between April 2022 and April 2023, identifying the coexistence of two care perspectives: a paternalistic one, centered on adult accompaniment, and another oriented toward fostering autonomy and the exercise of rights. The paternalistic perspective is based on perceptions of risk and trauma, which may restrict autonomy in sexual and reproductive health. The study suggests that healthcare workers should integrate an intersectional approach to ensure relevant and nonjudgmental sexual and reproductive health care, incorporating the relational dimension of autonomy, particularly for vulnerable and priority groups.

This article offers a critique of the hegemony of the factory model as the organizational matrix of social institutions. This factory model has hindered an understanding of both the ontological complexity of the social world and the singularity of territories. Drawing on a theoretical articulation that includes contributions from Nietzsche, Spinoza, Bourdieu, Elias, Santos, Deleuze and Guattari, as well as traditions from critical geography and institutional analysis, the text argues that the uncritical adoption of the industrial paradigm dehumanizes and fragments social problems, reinforcing the reproduction of social inequalities. It examines how, in the nineteenth century, the relationships between states and professionals developed within "processes of integration and differentiation" that excluded territories. In contrast, the article underscores the need to design small-scale, rhizomatic, relational, and playful institutional arrangements capable of engaging with situated forms of knowledge and strengthening processes of publicizing social problems within territories. The article concludes that transforming social fields requires abandoning the factory imaginary, recovering the artisanal character of social work, and building institutions rooted in the power of territories, proposing that "the way out of the labyrinth is from above."

In Chile, childhood rehabilitation is recognized as a right supported by regulatory frameworks. However, its implementation presents limitations that restrict access and continuity of care, and the experiences and strategies of women caregivers who use the system have received limited attention in the design and evaluation of public policies. In this context, this article characterizes the therapeutic rehabilitation pathways of children with disabilities in the western area of Santiago, Chile, from the perspective of their primary caregivers. Between August 2023 and March 2024, drawing on a qualitative methodology with an ethnographic approach, participant-observation accompaniment, recorded in field notes, and semistructured interviews were conducted with 13 women. The findings reveal fragmented trajectories marked by multiple barriers to access, a high burden of family management, and discontinuities in care. Four key moments were identified: suspicion and diagnosis, institutional transitions, development of interventions, and therapeutic discharge. Caregivers sustain care processes through everyday strategies that integrate public, community-based, and private forms of support. Within this framework, the article discusses the limitations of current public policies and reinterprets rehabilitation as a contextualized practice sustained by affective and unequal care networks.