Scientific-medical societies. Approach to an ethical framework

Introduction

Conscience is what you are, reputation is what others think you are.” Albert Einstein.

The social significance of public health and current scientific practice poses new responsibilities that drive scientific-medical societies to assume a public commitment, freely adopted and voluntary responsibility expressed through a Code of Good Practices [1], as a Code of Medical Ethics [2], or as a Code of Ethics of the scientific society [3,4] or as a Code of Ethics of the profession [5] and also as an Ethical Framework [6,7], in short, an ethical itinerary. Although it is a fact that there are many Spanish, as well as international, scientific-medical societies that have a Code of Ethics, it is a reality that little study has been studied on its argumentation and disclosure among the new members that join, the civil society, the patients, and other agents. Therefore, we propose to make a review and description of what is published, to deeper into approval of values and decalogue of principles to consider, which serves as a reference to scientific-medical societies that already have an ethical itinerary, for their evaluation, and to those who intend to do it again, so that they have a reference on the minimum values that should be outlined.

A scientific society needs experts with scientific rigor, who are people with values and who defend them with greatness, respecting and giving prestige to the society to which they belong [8].

The ethics of a scientific society or a company can no longer focus on the mere elaboration of an ethical code but must encompass a new moral culture of “convinced and shared responsibility” for the entire organization, especially when it comes to developing and applying quality accreditation or evaluation systems [7,9].

Ethical reflection should not be seen as something abstract, ethereal, or complicated, but as a way to resolve a conflict, something that can be fascinating, and that requires knowledge and methodology. It is of interest to bet on ethics because it will solve the problems of the future [10].

The ethics of organizations can be defined as the set of processes that address ethical problems inherent in the areas of professional, educational, and contractual relations, as well as economic, financial, and management areas of the organization [11].

Your partners and your representation are your most valuable assets when developing your professional activity. They must therefore be developed by high levels of professional excellence and personal ethics, without distinctions of the level of responsibility or areas in which their activity is carried out, with a code of conduct of the profession, which guides the professional in the daily exercise, of their activities [5,12].

Organizational ethics must include the courage to have values since in real life one works in a team [13]. On the other hand, social organizations contribute to shared social responsibility and need their middle managers to add value to other members who are closer to the client. The leaders of the scientific society must create new leadership that permeates the corporate reputation of all its members [14].

The decisions of managers at all levels must have prudential and moral reasons, they will necessarily be scrutinized by a legal and ethical barometer [9]. In these crazy times, when reflection is a luxury and everything can be otherwise, doubt allows the intellect to distance itself, not give in to the spontaneity of the first impulse, and, with a reflective and prudent attitude, have an answer to every dilemma [15].

The search for excellence is the attitude of the good professional and the good professional to achieve ethical and professional values that go beyond compliance with the law, a contribution to professionalism for the attitude of excellence5. Today, total quality management is conceived as closely linked to excellence [11,12]. The different codes always refer to a preamble, some general principles, the duties of the patient, the duties of other health professionals, and the duties with society; without forgetting the duties as partners of scientific-medical societies [2-5,16].

Maintaining the most demanding standards in terms of ethical behavior is part of our professional culture, it is an unavoidable individual responsibility that commits us to ourselves and to others. In Spain, there are ethical codes drawn up by various Scientific-Medical Societies that are reviewed in this document; The important question that we want to answer is the need to develop a common ethical framework model, aimed at any scientific society, which is concerned to develop an ethical commitment that bases the development of the activity of all professionals under certain same values ​​and ethical principles.

Purpose and scope of application

In this context, the objective of this work is to formally establish the values, references, and standards that should guide the behavior of physical and legal persons that are part of any scientific-medical society and thereby help to consolidate a culture of ethical conduct that must be accepted and respected for everyone. For this, the drafting of an ethical framework is proposed to serve as a guide and model of the ethical framework of any scientific-medical society.

This Code of Ethics and Good Practices summarize some expected behavior guidelines. It is a bastion of conduct that illustrates the main ethical considerations that we must bear in mind and execute in our activity and establishes some mandatory rules for entities and partners that are part of or collaborate as staff personnel in Scientific Societies and including partners, society, patients, sponsors and collaborators, administration and different professionals and different scientific societies.

Today, total quality management is conceived as closely linked to excellence. Undoubtedly, the ethics of organizations owes much to the quality of the processes [17] and in particular to the Joint Commission for Accreditation of Healthcare Organizations, which at the end of the 20th century already included the ethical climate and culture of the organization in the criteria for accreditation [11].

In the fourth industrial revolution, in which we are immersed, physical and biological digital technologies converge in a global and unequal world, and ingredients so new and of such magnitude are introduced, that the ethics of care goes beyond the limits of the theory of justice and flees from ideological slanders. This requires good data, and solvent interdisciplinary analysis based on scientific knowledge that provides a concrete basis for an ethical itinerary [18,19] and makes us more aware of how much we need each other in all human activities. Care is a strong ethic that takes us into the field of solidary personalism with its social principles (solidarity, subsidiarity, common good) and its great values such as truth, justice, equality, freedom, and participation [18].

The scope of application of this Ethical Framework extends to all partners and members of the Governing Board, trustees of the corresponding foundation, administrative staff, and suppliers in their relationship with both the Foundation and the Company. It must also cover all activities and forms of access to external financing. The richness of ethical considerations can be fundamental for economics, this raises an expansion of the set of variables and influences that exist in economic analysis as proposed by the Nobel laureate Amartya Sen [20].

It will be necessary that each one of the partners implicitly assumes the official position of the Company, in a ritual, which could be annual. The individual will maintain the ethics of the profession [5] will be specified, as well as exempting the commitment, respect for ethical values ​​, and excellence. Some minimum values will be established to be considered and that support a decalogue of principles of action and what responds to What is the right thing? How should I behave? What should my attitude be in front of the patient’s expectations? In the face of a discrepancy in a professional opinion, how should I proceed? Western philosophy in its educational system has been unconcerned with the education of citizens in values, and yet it is a fact that human beings continually value. The language of ethics is the language of values, and the main duty is to build and estimate values [21].

But this cannot protect any professional conduct of its associates and even more so if it seriously conflicts with their institutional duties. The healthcare professional and the partner are expected to uphold ethical values and excellence as a standard of conduct [16]. Also that corporate ethics be disclosed beyond its scope of application to provide civil society with better information on the application of good practices carried out by scientific society. Formally establish the values, references, and norms that should guide the behavior of natural and legal persons, as well as help consolidate a behavior that is accepted and respected by all [1].

Ethical values and excellence

The human being has the duty to build value and this is the performance of the duty, it is necessary to add value by putting it into practice, into reality. The construction of the person in the order of the good is called virtue. Good value is realized by executing the best and this is related to excellence. The word excellence has strong ethical connotations, and in the history of ethics, it has developed hand in hand with the ethics of virtue [22]. Excellence (areté in Greek), was translated as a virtue by the Latins and has to do with habits, attitudes, dispositions, or ways of life that bring us closer to an idea of perfection [23,24]. Peters and Waterman propose eight principles to achieve success and excellence, two of them are related to values and take people into account, but they emphasize the shared values that permeate organizations, making them their culture [11,25].

Certain action-oriented ethical values must be made explicit, as befits organizations. They are the moral minimums that translate into a duty of respect and also general principles of conduct. They are essential values to generate and strengthen trust in its institutional relationships, for the sake of an ethic of responsibility [26]. Brevity is also advocated in the Codes in the description of values so that they are fundamental and inspiring values [6].

• Integrity and rigor: Coherence between what is said, what is written, and what is done. It is goal orientation. It must set its programs and priorities without limitation to address relevant issues in a free, exhaustive, objective, and independent manner, remaining faithful to them, and not being able to be replaced by the interests of business entities in the health sector [1]. Scientific integrity must be the inspiring value and guarantor of good practice [27]. Research projects will always be carried out for the benefit of patients, to reduce their suffering, and/or to increase knowledge of science [28]. Professionals must pursue objective knowledge, based on verified and validated results. They must be responsible for the content of all their studies, reports, and publications and must include as authors those who have contributed significantly to their realization.
• Confidentiality: Duty to respect privacy in the care relationship, as well as the protection of personal and health data [11,29-31], having a special obligation to guarantee digital rights, both in care and research and teaching activities, with prospective studies and retrospective. The privacy of members' data from sponsors must be respected. The ethical management of data, to make fair use of personal data, in a digital world, is a requirement and a challenge since it is not only about names and surnames but the incorporation of any element that can lead to the identification of a certain subject. The general data protection regulation - RGPD (CNIL, s.f) - has been a global standard since it entered into force in May 2018, with other reference frameworks of good practices, to save, among others, the first risk, the necessary privacy [32]. Regarding the transmission of knowledge, it is necessary to respect the industrial and intellectual property policies of the institutions and the Society, in terms of authorship, the confidentiality of data, and disclosure of information by working groups in the development of research [1,33].
• Trust. Confidence, as a value, is not achieved overnight, it must be cultivated. It develops, like any human dimension, with the continuous repetition of actions of a good example, transparency in actions, and consistency with solid principles. The credibility and high reputation that the Company deserves from third parties to offer a good service to citizens, quality health care for patients and quality of life for users, continuous and ongoing training for its partners, frank cooperation with companies in the health sector, as well as generating respect and consideration from other Scientific Societies and social institutions [4,7]. Independence. Freedom of information and action in the field of health and disease is based on a solid knowledge of the Spanish reality, health care, and research in this field. Autonomy in managing your resources and full freedom. The Scientific-Medical Societies will have complete freedom when expressing their position on matters of a healthy nature in which the interests of any for-profit entity that finances the activities and purposes of the Organization may be involved. Scientific societies are a key piece in the health system due to their leadership capacity. This makes them an essential target for the pharmaceutical industry. Since the Scientific Societies do not have their own financial strength, they seek their source of income in the various contributions of the Pharmaceutical Industry. This turns those established between Scientific Societies and the Pharmaceutical Industry into relationships of interest, so the credibility, prestige, and independence of the Scientific Societies could be threatened. The keys to a healthy, ethical, and beneficial relationship for Scientific Societies are transparency and independence.
• Veracity: Transparency in the actions, in the declaration of conflicts of interest, and in the audit mechanisms. Offer intelligibility and rigor in health information, as well as provide the media with scientific disclosure that is far from bias or deception [7]. There are authors who prefer to speak of truth value instead of veracity [21].
• Dignity: Respect and promotion of human rights without discrimination of any kind, condition, or personal or social circumstance. Kantian ethics synthesizes it by defining dignity as the basis for treating the human being not only as a means but as an end in itself [24]. Humanizing is an ethical issue and when values lead us to perform care and ensure relationships associated with the dignity of every human being, we speak of humanization [34].
• Dialogue: Open and participative attitude towards its associates, other health professionals, and the rest of the citizens, entities, associations, and organizations, in the search for agreements. On the other hand, the holder of scientific knowledge must be the entire scientific community, and it is they who must receive the advance in knowledge [4]. Dialogue assumes intellectual honesty and the desire to peacefully resolve conflicts, exchanging accurate and truthful information in an attentive, cordial, and diligent manner. It requires the search for balance and fair consensus, considering the multiplicity and diversity of actors and interests.
• Civic commitment: Development of Scientific-Medical Societies, which include Pharmaceutical Societies at the local and regional levels, as well as collaboration with state and regional administrations in the health organization of our country and the improvement of health from pharmacotherapy, medical science, and technology applied to citizens. This collaboration will be carried out under the principles of cooperation and transparency and implies a capacity to respond to the needs, expectations, and health demands of the community based on justice and solidarity, which transcends our borders in the world of globalization [7]. This value is recognized by some authors as participation [18,21] and also, social responsibility and globalization. Civil society has in the ethics committees a guarantor so that there is an equitable distribution of the limited and available health resources, as well as ensuring the application of the ad hoc lex artist of the moment and with correct economic and political criteria [35].
• Justice: It is a value and an ethical principle in health relations. There is the individual good linked to the bioethical principles of beneficence, autonomy, and non-maleficence [4,36]. The fourth bioethical principle of justice refers to the common good, and the good of society as a whole, and health policy is based on it [37,38]. Justice is not equality, equality is only an aspiration, what is intended is that we be fewer unequal-Ralls' Principle of difference [23,39]. It is about the application of criteria of efficiency, transparency, and equity in the action, within the framework of the National Health System, although justice is applicable in the public and private health systems. The allocation of resources should not prioritize the most demanding but rather those most in need [12,40]. The prioritization will be done with an objective, generalizable, transparent, public, and consensual criteria, especially in the case of a public health system [41].
• Legality: Compliance with laws and other regulations in force, without thereby exhausting the scope of ethical obligations. Society demands a very exquisite performance from health professionals and their claims force judges to rule on the correctness and adaptation of the activity to good clinical practice or lex artis. Legal responsibility has rights and duties and it is a duty that generates responsibility [42,43].
• Honesty: The activity of the Societies and their Foundations, if any, in all aspects related to access to external financing and the destination of the same must be marked by honesty, which means committing and expressing such commitment with coherence and sincerity. Commercial financing cannot dictate the activities of the Organization because it would imply commodification of social purposes [4].

Ethical code of good practices of medical-scientific societies and their foundations

Both the Scientific-Medical Societies and their foundations are non-profit and non-governmental scientific entities, so their activities are guided by the highest degree of independence and integrity. This way of acting, oriented and embodied in the set of operating principles that make up an “Ethical Code of Good Practices (BP)” by which association, collaboration, and donor relations are regulated, guarantees a position in health policies with a lack of influence and vested interests.

The BP Code of Ethics, as part of an ethical itinerary, was born to cover all possible activities and forms of access to external financing by Scientific Societies, regulate the principles and rules in their recruitment, relations with private and public sponsors, and other entities of the same nature.

One part of the Code is intended to establish the operating rules for access to private financing and the regulation of relations with for-profit entities, and the other focuses on regulating the rules for establishing associations, collaboration, and contact with the different types of confluent entities in the activity of the Scientific Societies and their foundations.

The general principles that govern association, collaboration, and relationship agreements with various associations, institutions, and the technological-medical-pharmaceutical industry must assume the following commitments:

• The partners and trustees, their administrative and managerial staff, assume the commitment of convinced and shared responsibility that defines the Ethical Framework, making ethical values and professional excellence their own.
• Fundraising for activities establishes relationships with for-profit entities that come from third parties outside the Organization, either through donations or through sponsorship of educational and scientific activities, implying reciprocal relationships. It is necessary for Scientific Societies and their foundations to be open and transparent, consistent with their goals and the ethical values shared individually on the one hand as professionals5 and on the other as an Organization (BP Code of Ethics), guaranteeing that their partners are aware of the rules of conduct, disseminating the BP Code of Ethics to the people and financing entities and the project object of support to the partners. The raising of financing for programs, activities, training, studies, or any project may only be carried out when they fit in with the purposes and objectives of the companies. The Organization will not accept any type of financing that implies compensation or retribution directly or indirectly to any type of agent or third party, for raising funds. The effective, efficient, and effective use of sponsorships, subsidies, and contributions obtained to finance their activities will be guaranteed. This is not a financial transfer, but rather a reciprocal relationship with sponsors, donors, and collaboration with other scientific associations, universities, and administrations.
• In relation to marketing actions, the function of each of the parties in relation to said activity must be evidenced, through the expressions "sponsored by" and "organized by", maintaining the corporate identity of the Organization. They may not solicit or accept any financing or sponsorship offer that links their name or logo to a product, service, or commercial activity that leads to the promotion or advertisement of drugs for personal benefit. The prohibition of secret sponsorships, as well as anonymous donations, will be vetoed by the Organization, which will establish the appropriate precautions. The privacy of members' data will also need to be protected from sponsors [32]. The partners for their part will be informed of the existence of sponsorship, identity, and business activity.
• Transparency in general and accounting, in particular, undertakes to be accessible to all information, be it economic, management, external relations, and internal documentation of the Organization [1]. Transparency must be acted upon and it must also be promoted and demanded of all partners, the pharmaceutical industry, patient associations, the administration, and civil society in general. It is a primary tool against corruption and bribery, not only to apply and value justice, but also because corruption is not only tackled with legal regulations, there must be social awareness that permeates a culture of what is right as duty [42] and what is not correct, is corrupt. Economic transparency and the flow of ideas, information, and reciprocal experiences will be the result of collaboration. For this reason, the financing of projects or activities whose disclosure is made through works and/or scientific publications must transmit relevant information33. The official organ of scientific expression of the Society is the corresponding Journal of the Society, it will maintain the standards of scientific quality and the relevance of its values. Regarding the regulation of association and collaboration relations, the Governing Board will carry out the individual assessment and evaluation of the association and sponsorship opportunities, as it could not be otherwise, maintaining the coherence of purposes and objects, the values of shared ethics, and mutual, equitable and real benefit.
• Corruption and conflicts of interest are generated when, in a social or labor relationship, there are elements that can condition its harmonious and free development. In biomedical research and practice, the presence of a certain conflict of interest has always been evident due to the presence of factors capable of distorting its primary goals, such as the well-being of the patient, obtaining valid knowledge in research, and the interest of science or society [4,28]. A large proportion of them is generated due to the fact that most research projects, and many cares and continuing education actions are financed, to a greater or lesser extent, by the technological-medical-pharmaceutical industry [4,10].

Likewise, it is the right and duty of the parties to maintain the confidentiality of the sponsor, taking into account the exclusion of personal benefit both for themselves and for family, friends, partners, colleagues, or any third party personally linked. For these purposes, the fees or economic compensation received for teaching, presentations or intellectual property rights for publications will not be considered a personal benefit, provided that the amount of said remuneration is within the range of remuneration used by Scientific Societies.
With all their sponsorship contracts, the right of the sponsors to obtain disaggregated information on the items of expenses related to the activity being sponsored will be expressed in the principles that govern the relationship with the sponsors [1].
Conflicts of interest can have very diverse origins and cannot be identified with an act of misconduct, per se. A widespread error consists of identifying the conflict of interest with an act of misconduct, plagiarism, or fraud, and this does not have to be the case, since it is correct when someone shows transparency, legality, and honesty, and presents documented a conflict of interest that disqualifies him from a specific activity [44]. It is a fact that they are not only derived from economic issues. It is easy to understand that professional or personal conflicts generated by arrogance or intellectual vanity are more difficult to demonstrate than those caused by coins [10].
When a conflict materializes illegally, the honesty of the professional is immediately called into question. The judgment on the action extends to the affected service or work team; second, to your hospital; and thirdly, to its professional group. The repercussion of the conflict on the affected professionals has a clear social significance, as it harms the population in general or a certain sector of it23. It would be utopian to think that this type of conflict is going to disappear, however, the most important thing is not the ethical codes or the legal regulations, what is fundamental is the ethical training of researchers and those responsible for the pharmaceutical industry specifically and in a technological-medical-pharmaceutical [1,45].
In any case, and to avoid misunderstandings, those involved in any activity, presentation, book, course, article, moderator, etc. should be required. the explicit, detailed presentation with the intention of reporting all the conflicts in which the subject is involved. Any real, apparent, or potential conflict of interest that may unduly influence or compromise the proper performance of the research activity must be declared [27].
In other cases, the delivery and acceptance of gifts and presents will be permitted when the following circumstances simultaneously occur: they are not prohibited by law; involve usual courtesy gestures; are of irrelevant or symbolic economic value, and are generally accepted business practices in the particular environment, or are specifically authorized by the Organization.
The ethics of the pharmaceutical industry must have the person and health as its horizon, and this ethical assessment must prevail over the purposes of profitability and competitiveness, among others, in relations with Society [45].

• Corporate reputation. The respect and correct and adequate use of the logos and corporate images of the Company and Foundation and each of their associates, contractors, and any other collaborators1 will be monitored. Strongly centralized control will be harmoniously and simultaneously combined to preserve the essential values of the Company and at the same time an absence of control, freedom of action, and flexibility in promoting the freedom, integrity, and leadership of the associates. People who are part of the Organization must be especially careful in any public intervention and must have the necessary prior authorization to report to the media or to participate in professional conferences, seminars, or any other format that may have public dissemination, provided that they appear as adhered professionals on behalf of the Company.
• Professionalism is the way to carry out the professional activity with total commitment, restraint, and responsibility and is therefore closely linked to corporate reputation. It includes the specific training of each one who must maintain the pre-established ethical, humanistic, scientific, technical, and technological standards. Undoubtedly, this is a tool against the incipient lack of professionalism in health sciences and professionalism [1,4]. Best practices and reduction of care variability will be promoted to achieve health protection.
• Accessibility. It is convenient to articulate procedures to respond to partners who request ethical advice. The organization will promote participatory access for all members who wish to do so in activities of the Company and Foundation such as training, presentations, publications, organization of conferences, and courses... so that the Company is enriched with the greatest possible presence of members and Personalism are avoided, favoring equality and transparency.

Regulatory compliance area

Once the commitment of the professionals that make up the Company has been accepted, it is established that the area of compliance with the Ethical Framework extends to all activities, and there must be public knowledge and acceptance of the rules of conduct of the BP Code of Ethics by all parties.

The Company will have in its governing bodies the guarantor of the correct conduct that defines the Ethical Framework of the Company as a reality, de facto it will be necessary to bear in mind the precautionary principle, not only in matters of technical, scientific, and economic nature but also to have sufficient response capacity to quickly redirect behaviors that are not correct in the Ethical Framework and reduce the damage inflicted if it had occurred [46].

In any case, the sanctioning nature is usually carried out by the Ethics Committee of the Official Medical and Pharmaceutical Associations [4,10,47].

In case of ethical conflict, the legitimacy of the Ethical Framework of the Society will be done with the call of the Ethics Committee, the permanent commission of the Scientific Society, and its functionality will be clear if the conflicts are resolved after a critical discernment, which leads to prudential solutions, agreed that, together with specific training and training in good conduct, are aimed at maintaining the desirable ethical climate in any Organization [35,46,48].

Conclusion

In conclusion, the Scientific-Medical Societies, aware of their responsibilities, and making use of their self-regulatory power, must establish internal rules of public importance that allow defining the ethical limits in their activities for the achievement of the foundational object and purposes of scientific institutions. The commitments and responsibilities that are binding on the professionals are determined in the ethical itinerary, an individual attitude of maximum ethics that seeks excellence as health professionals, and an ethical canon is linked to all partners, employers, administrative staff, and agreements of association, collaboration, and various relationships that assume the commitment that marks the Organization [1,5,12].

Scientific Societies entrust the preparation of an Ethical Framework to the Ethics group of their Organization. This framework arises as a response to institutional concerns; In this way, they contribute to promoting dialogue with interested institutions, organizations, and administrations, with the transparency of their activities, offering themselves as a meeting forum [1,7]. The Ethical Framework aims to be the ethical climate, which seeks to overcome the field of clinical bioethics and advances in the ethics of organizations. This reflection will allow pragmatic attitudes not to be an option that can plunge us into mediocrity, triviality, and vulgarity mediated by the lesser evil and the fear of negative consequences for certain interests. The leaders of the Scientific Societies must contribute values that permeabilize the corporate reputation [14].

1. Code of good practice of the federation of scientific-medical associations (FACME) V.4. 2021.https://facme.es/wp-content/uploads/2021/12/Borrador-CBP-Asamblea-General-FACME-22122021.pdf
2. Word Medical Association WMA. Internacional Code of Medical Ethis. 2018. Disponible en: https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/
3. SEME. Code of Ethics of the Spanish Society of Aesthetic Medicine. 2021. https://www.seme.org. /la.seme/Código ético
4. SEO. Code of Ethics of the Spanish Society of Ophthalmology. 2019. https://wwwoftalmoseo.com
5. Barreda Hernández D, Bellver Capella V, Del Moral García A, Díaz del Campo Lozano J, Francés Causape MC, González Bermejo D. Pharmaceutical Code of Ethics. 2015. https://www.sefh.es/sefhpdfs/trip_codetico.pdf
6. SEMI. Ethical Framework of the Spanish Society of Internal Medicine 2015. https://docplayer.es9832633_marco-etico-de-la-sociedad-española-de-medicina-internahtm
7. De los Reyes M, Martín C, Brugada, J, Sanz, J, Lidín R.M, Martín F. Ethical framework of the Spanish Society of Cardiology. Rev Esp Cardiol. 2006; 59(12):1314-27.
8. Garrigues Walker A. Pragmatism. 2020. https://www.gref.org/nuevo/articulos/ABC_Pragmatismo_SCAN.pdf
9. Cortina A, Conill J. Ethics, business and health organizations. In Simón P, coord. Ethics of health organizations. New models of quality, Madrid: Association of Fundamental and Clinical Bioethics. Triacastela. 2005:15-32.
10. López Guzmán J. Applied pharmaceutical ethics. Madrid: Alcalá Formation; 2014.
11. Simón, P. Ethics of health organizations. New quality models. Madrid: Tricastela; 2005.
12. Barreda Hernández D, Mulet Alberola A, González Bermejo D, Soler Company E. The reason for having a code of pharmaceutical ethics: Spanish Pharmacists Code of Ethics. Farm Hosp. 2017 May 1;41(3):401-409. English. doi: 10.7399/fh.2017.41.3.10611. PMID: 28478754.
13. Marco Ll. y Román B. Individualization at work and knowledge organizations. 2022.>https://www.hobest.es/individualizacion-en-el-trabajo-y-organizaciones-del-conocimiento/
14. Marcet X. Grow inside. 2022. https://www.lavanguardia.com/economia/20220710/8396019/empresas-mandos-jefes-empleados-capas-conocimiento.html
15. Camps V. In Praise of Doubt 6th Ed. Harp 2016.
16. Code of Ethics: Spanish Society of Medical Oncology (SEOM) and SEOM foundation. 2019.
17. Potter RL. From clinical ethics to organizational ethics: the second stage of the evolution of bioethics. Bioethics Forum. 1996; 12(2):3-12.
18. Martínez JL. For an ethic of care. 2020. https://www.abc.es/opinion/abci-julio-martinez-etica-cuidado-202006052255_noticia.html
19. López M. Care: an imperative for Bioethics. Madrid: The Pontifical of Comillas; 2011.
20. Sen A. On ethics and economics. Madrid: Publishing Alliance; 2020.
21. Grace D. Building values. Madrid: Tricastela; 2013.
22. Gracia D. Value management. Reception as academician of the Royal Academy of Moral and Political Sciences., RACMP, Madrid. 2011:142-57.
23. Abellán F, Barreda D, López J, Requena T, Sánchez-Caro J, Soler E. Clinical Ethics in Hospital Pharmacy. Madrid: Health Foundation; 2000:2012.
24. Gracia D. Moral deliberation: the method of clinical ethics. Med Clin. 2001; 117(1):18-23.
25. Peters T, Waterman R. In search of excellence. Madrid: HarperCollins Iberian; 2017.
26. Gracia D. Quality and excellence in health care. In Lolas F. Bioethics and health care. Equity, quality, rights. Santiago de Chile PAHO/WHO 2000. 35-45.
27. National Declaration on Scientific Integrity. Confederation of Scientific Societies of Spain (COSCE), Higher Council for Scientific Research (CSIC) and CRUE Spanish Universities. 2015.https://www.csic.es/sites/www.csic.es/files/Declaracio_n%20Nacional%20Integridad%20Cienti_fica%20definitiva_0.pdf
28. Declaration of Helsinki of the World Medical Association. 64th General Assembly; Brazil, 2013; 9a revisión. JAMA. 2013; 310(20):2191-4.
29. Regulation (EU) 2016/679 of the European Parliament and of the Council of April 27, 2016 regarding the protection of natural persons with regard to the processing of personal data and the free circulation of these data and by which repeals Directive 95/46/EC (General Data Protection Regulation).
30. Organic Law 3/2018, of December 5, on the Protection of Personal Data and guarantee of digital rights.
31. Gracia D, Rodríguez-Sendín JJ, Coordinators. Privacy, confidentiality and secrecy. Madrid: Foundation for Health Sciences-Foundation for training (Collegiate Medical Organization); 2005.
32. Buenadicha C, Galdon G, Hermasilla MP, Loewe D, Pombo C. The ethical management of data. International Development Bank. 2019.
33. CBE. Spanish Bioethics Committee. Recommendations of the Bioethics Committee of Spain in relation to the promotion and implementation of good scientific practices in Spain. 2010. http://assets.comitedebioetica.es/files/documentacion/buenas_practicas_cientificas_cbe_2011.pdf
34. Soler E, Barreda D. Humanizing pharmaceutical care from the Hospital Pharmacy. OFIL 2018.28:287-288.
35. González Bermejo D, Solano MD, Polache J, Mulet A, Barreda D, Soler Company E. Healthcare Ethics Committees and Research Ethics Committees in Spain: organization, regulation and functions. OFIL·ILAPHAR. 2020.
36. Beauchamp TL, Childress JF. Principles of biomedical ethics. 4th ed. Barcelona: Masson; 1999
37. Carballo F, Júdez J, De Abajo F, Violán C. Rational use of resources. In: Gracia D, Júdez J, editors. Ethics in clinical practice. Madrid: Triacastela/Health Sciences Foundation; 2004; 213-48.
38. Herranz G. The contribution of medical ethics to the Administration of Justice. In: De la Mata I, coordinator. Bioethics and justice. Madrid: Ministry of Health and Consumption-General Council of the Judiciary; 2000; 133-59.
39. Gracia D. What is a fair system of health services?. Principles for the allocation of scarce resources. In: Medical profession, research and health justice. Santa Fe de Bogotá: The Owl; 1998.
40. Morillo Verdugo R, Margusino Framiñan L, Monte Boquet E, Morell Baladrón A, Barreda Hernández D, Rey Piñeiro XM. Positioning of the Spanish Society of Hospital Pharmacy on Telepharmacy. Recommendations for its implementation and development. Hospital Pharmacy 2020; 44(4).
41. Ministry of Health. Government of Spain. Report of the Ministry of Health on ethical aspects in pandemic situations: SARS-COV-2. 2010.https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/AspectosEticos_en_situaciones_de_pandemia.pdf
42. Del Moral A. Criminal justice against corruption. Barcelona. Government of Catalonia; 2015.
43. Larios D. Types of responsibility of the specialist pharmacist in Hospital Pharmacy in Abellán-García (coord.) I Bioethical-legal Forum in Hospital Pharmacy. Madrid: SEFH, SMFH; 2011; 15.
44. López Guzmán J. Economic and ideological aspects of biomedical research: conflicts of interest. In: AA.VV. Biotechnology and posthumanism. Senior Cizur: Aranzadi; 2007; 283-314.
45. López Guzmán J. Ethics in the pharmaceutical industry: between economy and health. Pamplona: Eunsa; 2005.
46. Spanish Association of Bioethics and Clinical Ethics. Bioethical considerations before Covid-AEBI 19. 2020 [Consultado 28 Jul 2022]. Disponible en: https://www.cibir.es/es/bioetica/documentacion/biblioteca/covid-9/consideraciones-bioeticas-ante-el-covid-19-de-aebi
47. CGCOF. General Council of Official Colleges of Pharmacy Pharmaceutical Code of Ethics and ethics of the pharmaceutical profession. 2001. https://cofsalamanca.com/verDoc.aspx?tipo=11&doc=62
48. Barreda D. Healthcare Ethics Committee. More than a committee. Requena (Coord.) Ethical problems in the practice of the Hospital Pharmacist. Madrid:SEFH;2001. p. 31-7.