Gelyan Garcia

Prescribing antidepressants and benzodiazepines for patients with emotional distress is a common practice in primary healthcare that raises certain ethical questions. This paper has three aims. First, to describe the motivations that lead general practitioners to prescribe antidepressants and benzodiazepines in these cases. Second, to reflect on the ethical implications of such prescriptions based on the four principles of biomedical ethics defined by Beauchamp and Childress (autonomy, nonmaleficence, beneficence, and justice). Finally, to propose some recommendations for the mitigation of the medicalization of emotional distress in primary healthcare. Results show that general practitioners seek to alleviate patients’ suffering but their prescribing decisions are influenced by some uncertainties in clinical judgement as well as by systemic factors (patients’ pressures, time constraints, and unawareness of resources). Ethical issues arise in relation to the potential for dependence, the questionable long-term benefit of prescriptions, the uncritical fulfillment of patients’ expectations, and the impediment to address underlying social issues or to develop patients’ capabilities. Clinical consultation should be founded on effective communication between doctors and patients and a holistic care approach that acknowledges the psychological, social, and existential dimensions should replace a merely symptomatic approach. Some strategies to mitigate medicalization are proposed: the promotion of regular monitoring visits with patients and multidisciplinary collaboration, the enhancement of physicians’ knowledge about non-pharmacological interventions, as well as the establishment of an evidence-base for the effectiveness of these drugs in the primary healthcare setting.

In this paper, the structure of a southeastern Spanish population was studied for the first time with respect to its inbreeding patterns and its relationship with demographic and geographic factors. Data on consanguineous marriages from 1900 to 1969 were taken from ecclesiastic dispensations. Our results confirm that the patterns and trends of inbreeding in the study area are consistent with those previously observed in most non-Cantabrian Spanish populations. The rate of consanguineous marriages was apparently stable between 1900 and 1935 and then sharply decreased since 1940, which coincides with industrialization in Spain. A marked departure from Hardy-Weinberg expectations in the ratio of first cousin to second cousin marriages in the study population was observed. The high levels of endogamy and its significant steadiness throughout the twentieth century is noteworthy. Accordingly, our results show that exogamous marriages were not only poorly represented but also that this reduced mobility suggests that the choice of a mate was preferentially local. We found higher mobility in M22 with respect to M33 cousin mating. The relationships between population size and consanguinity rates and inbreeding fit power-law distributions. A significant positive correlation was observed between inbreeding and elevation. Many Spanish populations have experienced a prolonged and considerable isolation across generations, which has led to high proportions of historical and local endogamy that is associated, in general, with high \ values. Thus, assessing genomic inbreeding using runs of homozygosity in current Spanish populations could be an additional pertinent strategy for obtaining a more refined perspective regarding the population history inferred from the extent and frequency of ROH regions.