TEASUR: Ethical-Adaptive Theory of Relational Suffering. Proposal for a New Clinical-Bioethical Dogma for Latin America in theMultidimensional Approach to the End of Life

TEASUR: Ethical-Adaptive Theory of Relational Suffering. Proposal for a New Clinical-Bioethical Dogma for Latin America in theMultidimensional Approach to the End of Life | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article TEASUR: Ethical-Adaptive Theory of Relational Suffering. Proposal for a New Clinical-Bioethical Dogma for Latin America in theMultidimensional Approach to the End of Life Diaz-Perez Anderson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7359626/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background. End-of-life suffering in Latin America is a multidimensional phenomenon (physical, psychological, social, and spiritual) that is often overlooked in biomedical models. Structural inequities, normative gaps, and cultural barriers exacerbate this ethical blindness, limiting proportional and contextual palliative care. Objective. To present and validate the Ethical-Adaptive Theory of Relational Suffering (TEASUR), a Latin American bioethical-computational framework that integrates multidimensional suffering in clinical decision-making using ethically aligned artificial intelligence. Methods. A critical theory approach combined narrative review, logical-formal analysis, and computational simulations. TEASUR calculates a Total Distress Index (STI) by integrating four dimensions of suffering (physical, psychological, social, and spiritual), weighted by context-specific variables (gender, socioeconomic status, regulations, and advance care planning). Implemented in Python, the system includes interactive dashTables, automated bioethical narrative reports, and explainable AI (XAI) using SHAP. The validation was carried out with 300 synthetic cases from five Latin American countries, with Monte Carlo sensitivity analysis and comparisons with FACIT-Sp and ESAS-R. Results. TEASUR showed greater sensitivity than conventional scales in identifying social and spiritual suffering. In cases with high STIs (>7.0), the system activated narrative, spiritual, and community interventions, reducing suffering to non-critical levels and avoiding disproportionate measures such as immediate palliative sedation. The adaptive logarithmic decision flow allowed for culturally situated and ethically proportional responses, with transparent AI explanations supporting deliberation. Conclusions. TEASUR operationalizes suffering as a quantifiable, relational and morally traceable variable, offering a novel computational model of ethics by design from and for Latin America. Its modular and explainable architecture aligns with trusted AI principles and provides a replicable framework for ethically grounded, context-aware decision-making in hospital and community palliative care. Ethical AI palliative care relational suffering computational bioethics relational autonomy Latin America explainable AI Full Text Additional Declarations No competing interests reported. Supplementary Files teasurreproducible.py TEASURdatasetsinteticoingles.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7359626","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":499827484,"identity":"0056b19b-0b08-4ad6-a2c6-84ecc2dbb76f","order_by":0,"name":"Diaz-Perez Anderson","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYHACAwaGiv88bOwNILYFsVrOMMvw8RwAsSWI1MLYxmwjJ5EA4hChhX9288bHFWxsPGySz69u+FEgwcDf3p2AV4vEnWPFhmd4eHjYpHPKbvYAHSZx5uwG/NbcyDGTbJCQAGlJu8ED1GIgkYtfi/yNHPOfDQYGQIedSbv5hxgtBkBbGBsSEnjYJNiP3SbKFsMbacWSDQcO8LDx5LDdljGQ4CHoF7kbyRs/Nv47YC/ffvzZzTd/bOT423sJeB8BeAzAJLHKQYD9ASmqR8EoGAWjYAQBANy3QoF0lSOFAAAAAElFTkSuQmCC","orcid":"","institution":"Universidad Simón Bolívar","correspondingAuthor":true,"prefix":"","firstName":"Diaz-Perez","middleName":"","lastName":"Anderson","suffix":""}],"badges":[],"createdAt":"2025-08-13 00:53:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7359626/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7359626/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89079121,"identity":"947399e5-081d-48b4-9aa5-af66daab00c0","added_by":"auto","created_at":"2025-08-14 12:40:06","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":814646,"visible":true,"origin":"","legend":"","description":"","filename":"TEASUREthicalAdaptiveTheoryofRelationalSuffering..pdf","url":"https://assets-eu.researchsquare.com/files/rs-7359626/v1_covered_73dd2762-1357-4038-aab9-b49de5835b80.pdf"},{"id":89076634,"identity":"f543350a-a75c-45ef-b41e-fdcfced582f5","added_by":"auto","created_at":"2025-08-14 12:16:01","extension":"py","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":20844,"visible":true,"origin":"","legend":"","description":"","filename":"teasurreproducible.py","url":"https://assets-eu.researchsquare.com/files/rs-7359626/v1/a493720662a9a6909a2762d5.py"},{"id":89076637,"identity":"cd500134-869e-491a-844d-d4af11f2f2df","added_by":"auto","created_at":"2025-08-14 12:16:01","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":35964,"visible":true,"origin":"","legend":"","description":"","filename":"TEASURdatasetsinteticoingles.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7359626/v1/9160e8d9e780d79de67d9fae.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"TEASUR: Ethical-Adaptive Theory of Relational Suffering. 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Structural inequities, normative gaps, and cultural barriers exacerbate this ethical blindness, limiting proportional and contextual palliative care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective. \u003c/strong\u003eTo present and validate the Ethical-Adaptive Theory of Relational Suffering (TEASUR), a Latin American bioethical-computational framework that integrates multidimensional suffering in clinical decision-making using ethically aligned artificial intelligence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods. \u003c/strong\u003eA critical theory approach combined narrative review, logical-formal analysis, and computational simulations. TEASUR calculates a Total Distress Index (STI) by integrating four dimensions of suffering (physical, psychological, social, and spiritual), weighted by context-specific variables (gender, socioeconomic status, regulations, and advance care planning). 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The adaptive logarithmic decision flow allowed for culturally situated and ethically proportional responses, with transparent AI explanations supporting deliberation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions. \u003c/strong\u003eTEASUR operationalizes suffering as a quantifiable, relational and morally traceable variable, offering a novel computational model of ethics by design from and for Latin America. Its modular and explainable architecture aligns with trusted AI principles and provides a replicable framework for ethically grounded, context-aware decision-making in hospital and community palliative care.\u003c/p\u003e","manuscriptTitle":"TEASUR: Ethical-Adaptive Theory of Relational Suffering. 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