Percepciones sobre la aplicación de principios bioéticos en mujeres puérperas en un Hospital público del Ecuador

Fundamento: El puerperio es el periodo de tiempo que comienza en la finalización del parto hasta las seis semanas posparto; durante el cual, es necesario brindar atención conforme a los principios bioéticos inscritos en la normativa de salud vigente en el Ecuador. Objetivo: Analizar las percepciones que tienen las mujeres puérperas sobre la aplicación de los 4 principios bioéticos durante la atención en salud. Metodología: El estudio es de tipo descriptivo con enfoque cualitativo. Los datos corresponden a 10 mujeres puérperas mayores de edad, atendidas en el Hospital Gineco Obstétrico Pediátrico de Nueva Aurora "Luz Elena Arizmendi" de la ciudad de Quito, que respondieron a una entrevista sobre los principios bioéticos aplicados en la atención recibida. Se realizaron análisis de contenido a través del software ATLAS TI versión 23. Resultados: Se obtuvo una percepción positiva de las mujeres puérperas acerca de la aplicación del principio de justicia. Por otra parte, se evidencian dificultades en el de autonomía, sobre todo en la comprensión de la información brindada a la paciente acerca de los procedimientos durante el parto y puerperio, además de coacciones por parte del personal sanitario. Se percibe el consentimiento informado como un mero trámite administrativo. El principio de beneficencia se lo asume como parte de la vocación del personal y la no maleficencia genera malestar si no va acompañado de información clara y oportuna. Conclusiones: Los principios bioéticos son transversales en la normativa de salud vigente, pero sobresale el de justicia en la atención a mujeres puérperas.

Background: The puerperium is the period of time beginning at the end of labor until six postpartum weeks; during which it is necessary to provide attention in accordance with the bioethical principles included in the current health guidelines in Ecuador. Objective: To analyze the perceptions that postpartum women have about the 4 bioethical principles application during health care. Methodology: The study type is descriptive with a qualitative approach. The data correspond to 10 adult postpartum women assisted at the Nueva Aurora "Luz Elena Arizmendi" Pediatric Obstetric and Gynecological Pediatric Hospital in the Quito city, who responded to an interview about the bioethical principles applied in the received care. Content analysis was conducted through ATLAS TI version 23 software. Results: A positive perception was obtained from postpartum women concerning the application of the Justice principle. Furthermore, difficulties are evident in the Autonomy section, mainly in the comprehension of the information provided to the patient about the procedures during the labor and puerperium, as well as coercion by health personnel. Informed consent is perceived as a mere administrative formality. The Beneficence principle is assumed as part of the vocation of the personnel and Non-maleficence generates discomfort if it is not accompanied by clear and opportune information. Conclusions: Bioethical principles are transversal in current health guidelines, but that of Justice stands out in the care of postpartum women.

Estudio transversal en profesionales de la salud sobre aplicación y percepción de conocimientos bioéticos adquiridos en urgencias pediátricas / Estudio transversal en profesionales de la salud sobre aplicación y percepción de conocimientos bioéticos adquiridos en urgencias pediátricas

Introducción En comparación con ciencias clínicas básicas o aplicadas, la bioética es considerada una disciplina secundaria y subutilizada en la práctica diaria. Sin embargo, el razonamiento ético es indispensable para la calidad del cuidado. Existen pocos estudios sobre bioética en unidades de emergencia pediátrica. Nuestro objetivo fue evaluar la percepción sobre la importancia y la suficiencia del conocimiento teórico adquirido y la aplicación de los principios bioéticos en casos estandarizados. Métodos Realizamos un estudio descriptivo transversal en profesionales médicos y de enfermería que se desempeñan en unidades de emergencia pediátrica de Puerto Montt. Mediante una encuesta, evaluamos la percepción de la importancia y suficiencia del conocimiento bioético obtenido y la aplicación de los principios bioéticos en casos hipotéticos, pero probables, en la atención de urgencias pediátricas. Resultados De una población total de 50 médicos y 53 enfermeras, participaron en nuestro estudio 30 médicos (60%) y 20 enfermeras (37,7%). La mayoría reportó formación ética en pregrado (84%). Una minoría reportó formación durante la práctica (20%). Sin embargo, sólo 60% percibía tener conocimientos suficientes de bioética y 72% la consideraba importante para la práctica diaria. Además, al aplicar los principios de Beauchamp y Childress a casos clínicos estandarizados, el 82,7% no reconoció el principio de justicia y solo 50% reconoció los principios de autonomía y no maleficencia. Conclusión Aunque la mayoría de los profesionales de la salud tienen formación en bioética, el aprendizaje muchas veces se considera insuficiente y no se incorpora a la práctica diaria en las unidades de emergencia pediátrica.

Background Compared to basic or applied clinical sciences, bioethics is frequently considered as a secondary discipline and underutilized in daily practice. However, ethical reasoning is indispensable for the quality of care. There are few studies on bioethics in pediatric emergency units. Our objective was to evaluate the perception of the acquired bioethical knowledge and the application of bioethical principles in standardized cases. Methods We conducted a cross-sectional descriptive study in medical and nursing professionals working at pediatric emergency units in Puerto Montt. Through a survey, we assessed the perception of the sufficiency of the acquired bioethics knowledge and the application of bioethical principles on hypothetical, but probable cases in emergency pediatric care. Results Of a total population of 50 physicians and 53 nurses, 30 physicians (60.0%) and 20 nurses (38.7%) participated in our study. The majority reported ethics training in undergraduate education: 84%. A minority reported training during practice: 20%. However, only 60.0% perceived having sufficient knowledge of bioethics and 72.0% considered it important for daily practice. Further, when applying the principles of Beauchamp and Childress to standardized clinical cases, 82.7% did not recognize the justice principle and only 50.00% the principles of autonomy and nonmaleficence. Conclusion Although most health professionals undergo bioethics training, learning is often considered insufficient and not incorporated into daily practice at pediatric emergency units.

Controversias éticas en la atención del aborto, fertilización in vitro y anticoncepción en la mujer

En relación con los procesos de reproducción, las evidencias científicas de los últimos años y la vasta y mejor información con la que se cuenta para medir y estimar los indicadores de morbilidad y mortalidad en salud reproductiva han llevado a definir nuevas estrategias en el marco del derecho a la salud que tienen las mujeres. Para algunas personas son planteamientos claros, pero para otros no tanto, generando a la luz de los principios de ética controversias que es necesario plantear y, si es posible, resolver. En ese sentido, se ha seleccionado para esta presentación el aborto, la reproducción asistida y la anticoncepción, temas actuales que suscitan opiniones diferentes o contrapuestas de personas o instituciones, no siempre producto de una reflexión, justa, honrada, no ideologizada, buscando el bienestar de las personas. A veces, es el resultado de la satisfacción de un interés personal o institucional.

In relation to reproductive processes, the scientific evidence of recent years and the vast and better information available for measuring and estimating morbidity and mortality indicators in reproductive health have led to the definition of new strategies within the framework of women's right to health. For some people these approaches are clear, but for others they are not so clear, generating controversies in the light of ethical principles that need to be raised and, if possible, resolved. In this sense, we have selected for this presentation abortion, assisted reproduction and contraception, current issues that raise different or opposing opinions of individuals or institutions, not always the product of a reflection, fair, honest, non-ideologized, looking for the welfare of people. Sometimes, it is the result of the satisfaction of a personal or institutional interest.

El trabajo educativo curricular desde el tema Medicamentos antiulcerosos en la asignatura Farmacología II / Curricular educational work on the topic of anti-ulcer medications in the subject Pharmacology II

El trabajo educativo consiste en transmitir un mensaje coherente desde la propia ciencia y estimula la motivación del aprendizaje de los estudiantes y su propia actividad cognoscitiva. El propósito de la educación médica superior es egresar un profesional integral; por tanto, se trata de instruir y educar a los estudiantes en los más altos valores patrióticos, morales y éticos en cada uno de los escenarios docentes, desde la propia ciencia. El objetivo de esta comunicación es ejemplificar algunos contenidos sobre la temática referente a medicamentos antiulcerosos en los que se puede intencionar el trabajo educativo desde la propia ciencia.

The educational work consists of transmitting a coherent educational message from science itself and stimulates the students' learning motivation and their own cognitive activity. The purpose of higher medical education is to graduate a comprehensive professional; therefore, it is about instructing and educating students in the highest patriotic, moral and ethical values in each of the teaching scenarios, from science itself. The objective of this research paper is to exemplify some content on the subject related to antiulcer drugs from which educational work can be intentioned from science itself.

ChatGPT y su impacto en la formación de competencias en terapeutas ocupacionales: una reflexión sobre la integridad académica / ChatGPT e seu impacto na formação de competências para terapeutas ocupacionais: uma reflexão sobre a integridade acadêmica / ChatGPT and its impact on competence training in occupational therapists: a reflection on academic integrity

Resumen El acceso público a la inteligencia artificial y específicamente el ChatGPT está presentando desafíos y retos en la formación profesional de los terapeutas ocupacionales. En este contexto, este ensayo busca describir el impacto de la inteligencia artificial, con énfasis en el ChatGPT, en la formación de terapeutas ocupacionales y proponer estrategias para integrar estas tecnologías en la educación superior desde una perspectiva integradora, ética y acorde a los valores y principios de la integridad académica. A pesar de que esta herramienta se puede utilizar para proporcionar conocimientos teóricos y favorecer el aprendizaje de contenidos, también representa un riesgo para las conductas deshonestas en el ámbito académico. Por tanto, es trascendental que los formadores puedan comprender su uso y fomentar metodologías experienciales que promuevan la creatividad, el pensamiento crítico y la reflexión. El desafío reside en la implementación de políticas y estrategias que promuevan el desarrollo de competencias profesionales y el uso ético y efectivo de estas tecnologías en la formación de futuros terapeutas ocupacionales, como declarar su uso en trabajos escritos, el modelaje por parte de los profesores y la integración en las metodologías de formación.

Resumo O acesso público à inteligência artificial e, especificamente, ao ChatGPT, está apresentando desafios na formação profissional dos terapeutas ocupacionais. Neste contexto, este ensaio procura descrever o impacto da inteligência artificial, com ênfase no ChatGPT, na formação de terapeutas ocupacionais e propõe estratégias para integrar estas tecnologias no ensino superior a partir de uma perspectiva integradora, ética e de acordo com os valores e princípios da integridade acadêmica. Embora esta ferramenta possa ser usada para fornecer conhecimento teórico e favorecer a aprendizagem de conteúdos, também representa um risco para comportamentos desonestos no âmbito acadêmico. Portanto, é fundamental que os educadores compreendam seu uso e promovam metodologias experienciais que estimulem a criatividade, o pensamento crítico e a reflexão. O desafio reside na implementação de políticas e estratégias que promovam o desenvolvimento de competências profissionais e o uso ético e eficaz destas tecnologias na formação de futuros terapeutas ocupacionais, como declarar seu uso em trabalhos escritos, modelagem por parte dos professores e integração nas metodologias de formação.

Abstract Public access to artificial intelligence, and specifically to ChatGPT, is presenting challenges in the professional training of occupational therapists. In this context, this essay aims to describe the impact of artificial intelligence, with an emphasis on ChatGPT, on the training of occupational therapists and proposes strategies to integrate these technologies into higher education from an integrative, ethical perspective, in line with the values and principles of academic integrity. While this tool can be used to provide theoretical knowledge and enhance content learning, it also poses a risk for dishonest behaviors in the academic realm. Therefore, it is essential that educators understand its use and promote experiential methodologies that encourage creativity, critical thinking, and reflection. The challenge lies in the implementation of policies and strategies that promote the development of professional skills and the ethical and effective use of these technologies in training future occupational therapists, such as declaring its use in written works, modeling by teachers, and integration into training methodologies.

Validez de la unidad nacional en el pensamiento de Fidel Castro para enfrentar la COVID-19 / Validity of national unity in the thought of Fidel Castro to face COVID-19

En el ideario de Fidel Castro se aprecian sus consideraciones acerca de la necesidad de la unidad para vencer cualquier obstáculo que pretenda detener el curso de la Revolución cubana, en lo fundamental dirigidas hacia las maniobras desestabilizadoras de los enemigos de la patria; sin embargo, esa convicción fidelista de que la unidad garantiza el triunfo está presente en la batalla que se ha librado, y aún se libra, contra la COVID-19, donde el pueblo, organizado en diversos sectores, continúa obteniendo resultados positivos en contra de esta pandemia. Es objetivo de estos autores compartir algunas de sus ideas que servirán de análisis e inspiración para su aplicación en el actual contexto epidemiológico.

In Fidel Castro's ideology, his considerations about the need for unity to overcome any obstacle that tries to stop the course of the Cuban Revolution are appreciated, fundamentally directed towards the destabilizing maneuvers of the enemies of the homeland; however, this Fidel´s conviction that unity guarantees victory is present in the battle that has been waged, and is still being waged, against COVID-19, where the people, organized in various sectors, continue to obtain positive results against this pandemic. It is the objective of these authors to share some of their ideas that will serve as analysis and inspiration for their application in the current epidemiological context.

Trascendencia de los Comités de Ética de Investigación en Seres Humanos en el Ecuador / Research Ethics Committees of Human Beings in Ecuador

INTRODUCCIÓN. Los Comités de Ética de Investigación en Seres Humanos deben proteger la dignidad, los derechos, el bienestar y la seguridad de los sujetos investigados; evalúan aspectos éticos, metodológicos y jurídicos de los protocolos de investigación, competencia otorgada por el ente sanitario del país que ameritó observar si se cumplió. OBJETIVO. Evaluar la situación de los Comités de Ética de Investigación en Seres Humanos, basados en la percepción del cursillista, la normativa, las repercusiones y consecuencias para mantener su condición activa y su trascendencia. MATERIALES Y MÉTODOS. Estudio descriptivo, transversal y ambispectivo con un universo de 1 327 profesionales del área de la salud y una muestra de 385 encuestados que expresaron su percepción sobre trece Comités de Ética de Investigación en Seres Humanos a nivel nacional, con revisión bibliográfica nacional e internacional, se excluyeron los suspendidos. Se aplicó encuesta validada online, período abril a octubre de 2019. Data analizada en Excel y SPSS versión 23. RESULTADOS. El 76,92% Comités de Ética de Investigación en Seres Humanos fueron de la ciudad de Quito. Los cursillistas percibieron que el 64,16%, no trascendieron en su labor; desconocieron que: la Dirección Nacional de Inteligencia de la Salud, cuestionó el nombramiento de algún miembro un 97,14%; el cuestionamiento estuvo basado en la norma vigente un 79,48%; sobre la aprobación del plan anual de capacitación en investigación, 2019, un 95,06%; el plan anual de capacitación específico un 77,40%, y no recibieron directrices ni retroalimentación en temas de capacitación en calidad de investigador, un 90,39%. Además, percibieron que los Comités fueron responsables de capacitar otros Comités de ética de Investigación en Seres Humanos, un 81,82% y a los investigadores, un 85,71%; que deben elaborar el plan anual de educación específica para los miembros del comité, un 89,35%. CONCLUSIÓN. Se identificó entre los problemas que los investigadores casi no los conocen y hay necesidad de actualizar la norma que afectó el funcionamiento. Los justificativos para mantener la condición activa no se cumplieron, se evidenció la necesidad de asesoría para los comités por parte de las autoridades competentes, sin lograr conformación consolidada con actores y repercutió en su trascendencia.

INTRODUCTION. The Research Ethics Committees on Human Beings must protect the dignity, rights, well-being and safety of the research subjects; evaluate ethical, methodological and legal aspects of the research protocols, a competence granted by the health entity of the country that merited see if it is done. OBJECTIVE. Evaluate the situation of the Ethics Committees for Research in Human Beings, based on the perception of the trainee, the regulations, the repercussions and consequences to maintain their active condition and their transcendence. MATERIALS AND METHODS. Descriptive, cross-sectional and ambispective study with a universe of 1,327 professionals in the health area and a sample of 385 respondents who expressed their perception of thirteen Research Ethics Committees on Human Beings at the national level, with national and international bibliographic review. those suspended were excluded. An online validated survey was applied, from April to October 2019. Data analyzed in Excel and SPSS version 23. RESULTS. 76.92% Human Research Ethics Committees were from the city of Quito. The trainees perceived that 64,16%, did not transcend in their work; they did not know that: the National Directorate of Health Intelligence, questioned the appointment of a member 97,14%; the questioning was based on the current norm 79,48%; on the approval of the annual research training plan, 2019, 95,06%; the specific annual training plan 77,40%, and did not receive guidelines or feedback on training issues as a researcher, 90,39%. In addition, they perceived that the Committees were responsible for training other Human Beings Research Ethics Committees, 81,82% and the researchers, 85,71%; that they must prepare the annual specific education plan for the members of the committee, 89,35%. CONCLUSION. It was identified among the problems that the researchers hardly know them and there is a need to update the norm that affected the operation. The justifications to maintain the active condition were not fulfilled, the need for advice for the committees by the competent authorities was evidenced, without achieving a consolidated conformation with actors and had repercussions on its importance. hardly know them and there is a need to update the norm that affected the operation. The justifications to maintain the active condition were not fulfilled, the need for advice for the committees by the competent authorities was evidenced, without achieving a consolidated conformation with actors and had repercussions on its importance.

El legado de Fidel Castro como premisa y fortaleza para el enfrentamiento a la COVID-19 / The legacy of Fidel Castro as a premise and strength to face COVID-19

RESUMEN Fidel Castro Ruz es una de las grandes personalidades de los siglos XX y XXI, hombre de dimensión nacional e internacional por la profundidad de su pensamiento y obra humanitaria. En Cuba constituye un referente obligatorio en el sector de la salud, la ciencia y la educación médica, así como en la batalla contra la COVID-19. El desafío del pueblo cubano contra la pandemia, desde marzo de 2020 hasta la actualidad, tiene como premisa el legado de Fidel. El artículo tiene como propósito valorar el pensamiento fidelista como premisa y fortaleza para el enfrentamiento a la pandemia en Cuba.

ABSTRACT Fidel Castro Ruz is one of the greatest personalities of the 20th and 21st centuries, a man of national and international dimension due to the depth of his thought and humanitarian work. In Cuba, it constitutes a mandatory reference in the health, science and medical education branch, as well as in the struggle against COVID-19. The challenge of the Cuban people against the pandemic, from March 2020 to the current time, has as its premise in the legacy of Fidel. The purpose of the article is to assess Fidel´s thought as a premise and strength to faceg the pandemic in Cuba.

Conocimientos sobre la aplicación de los principios de la Bioética en Licenciados en Enfermería / Knowledge about the application of the principles of Bioethics in Nursing Graduates

RESUMEN Fundamento: la Enfermería se reconoce socialmente como una de las profesiones orientadas a ayudar y cuidar la salud de las personas. Brindar una atención con calidad y eficiencia es una de las premisas fundamentales de este profesional, garantizada por el conocimiento y aplicación de los principios de la Bioética. Objetivo: determinar el nivel de conocimientos sobre los principios de la bioética en los profesionales de Enfermería de la provincia Villa Clara. Métodos: se realizó un estudio transversal, descriptivo, en el período febrero 2017-junio 2019. Se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción, histórico-lógico; y empíricos: cuestionario. Las variables definidas fueron: sexo, años de experiencia laboral, principios de la bioética, aplicación de los principios, error de aplicación y estado del conocimiento. Resultados: predominaron el sexo femenino y los graduados de más de 20 años en el ejercicio de la profesión. El principio Beneficencia fue bien aplicado entre los encuestados. Los errores detectados más frecuentes estuvieron en el principio No maleficencia. Predominó el estado de conocimiento medio sobre la temática analizada. Conclusiones: existen insuficiencias en los conocimientos sobre los principios de la bioética y su aplicación en la práctica profesional del Licenciado en Enfermería.

ABSTRACT Background: Nursing is socially recognized as one of the professions aimed at helping and caring for people's health. Providing quality and efficient care is one of the fundamental premises of this professional, guaranteed by the knowledge and application of the principles of Bioethics. Objective: to determine the level of knowledge about the principles of bioethics in the Nursing professionals of Villa Clara province. Methods: a descriptive cross-sectional study was carried out from February 2017 to June 2019. Theoretical methods were used: analysis-synthesis and induction-deduction, historical-logical; and empirical ones: questionnaire. The defined variables were: sex, professional background, principles of bioethics, application of the principles, application error and state of knowledge. Results: the female sex and the graduates of more than 20 years in the exercise of the profession predominated. The principle of Beneficence was well applied among the respondents. The most frequent errors detected were in the principle No maleficence. The average state of knowledge prevailed on the subject analyzed. Conclusions: there are deficiencies in the knowledge about the principles of bioethics and their application in the professional practice of the Nursing Graduates.

Principialismo no exercício da medicina e em processos ético-profissionais / Principlism in medical practice and ethical-professional lawsuits / Principialismo en la práctica de la medicina y en los procesos ético-profesionales

Resumo Este estudo objetiva mostrar a importância dos princípios bioéticos de Beauchamp e Childress e reafirmá-los na prática médica a fim de diminuir os números exorbitantes de processos ético-profissionais impetrados por iatrogenia. Além disso, busca-se elucidar as fases do processo de modo a informar a comunidade médica sobre seu andamento. Para tal, realiza-se atualização bibliográfica pautada no Código de Ética Médica, no Código de Processo Ético-Profissional e em guias práticos e dinâmicos aplicados aos princípios da bioética. Conclui-se que o exercício da medicina pautado na ética, além de ser justo e benéfico ao paciente, é também modo de resguardar o profissional de possíveis interpretações equivocadas sobre sua conduta.

Abstract This study aims to show the importance of the bioethical principles of Beauchamp and Childress, contributing to reiterate them in medical practices to reduce the exorbitant numbers of professional lawsuits brought about by iatrogenesis. Furthermore, the text tries to elucidate the phases these litigations undergo to give more information on the subject to the medical community. To this end, this research carries out a bibliographic review encompassing the Code of Medical Ethics, the Code of Ethical-Professional Litigation, as well as practical and modifiable resources applied to bioethical principles. We conclude that, besides being fair and beneficial to the patient, the practice of ethics-based medicine also serves to protect professionals from misinterpretations regarding their conduct.

Resumen El objetivo de este estudio es mostrar la importancia de los principios bioéticos de Beauchamp y Childress y reafirmarlos en la práctica médica, con el fin de reducir la exorbitante cantidad de procesos ético-profesionales provocados por la iatrogenia. Además, se busca dilucidar las fases del proceso ético-profesional para informar a la comunidad médica. Para ello, se realiza una actualización bibliográfica con base en el Código de Ética Médica, el Código de Proceso Ético-Profesional y guías prácticas y dinámicas aplicadas a los principios de la bioética. Se concluye que la práctica de la medicina basada en la ética, además de justa y beneficiosa para el paciente, también protege al profesional de posibles malas interpretaciones sobre su conducta.

Prioritization to ensure care in COVID-19 pandemic / Priorização para garantir cuidado na pandemia COVID-19

Abstract Objectives: to develop a flow to ensure care for all people with severe acute respiratory syndrome Coronavirus 2, offering from intensive care to palliative care, in an equitable and fair manner. Methods: the modified Delphi methodology was used to reach consensus on a flow and a prioritization index among specialists, the regional council of medicine, members of the healthcare system and the local judicial sector. Results: the score was incorporated into the flow as the final phase for building the list of patients who will be referred to intensive care, whenever a ventilator is available. Patients with lower scores should have priority access to the ICU. Patients with higher scores should receive palliative care associated with available curative measures. However, curative measures must be proportionate to the severity of the overall clinical situation and the prognosis. Conclusions: this tool could and will prevent patients from being excluded from access to the necessary health care so that their demands are assessed, their suffering is reduced, and their illnesses are cured, when possible.

Resumo Objetivos: desenvolver um fluxo para garantir o atendimento a todas as pessoas com Síndrome da Angústia Respiratória Aguda de forma equitativa e justa. Métodos: a metodologia Delphi modificada foi utilizada para obter um consenso sobre um fluxo e um escore de priorização entre especialistas do Conselho Regional de Medicina, membros gestores do sistema de saúde e setor judiciário local. Resultados: a priorização foi baseada na insuficiência aguda de órgãos, comorbidades, fragilidade e funcionalidade. O escore foi incorporado ao fluxo como fase final para construção da lista ordenada de pacientes que serão encaminhados para terapia intensiva, sempre que houver ventilador disponível. Pacientes com pontuações mais baixas devem ter prioridade de acesso à UTI. Pacientes com pontuações mais altas devem receber cuidados paliativos associados às medidas curativas disponíveis. No entanto, medidas curativas devem ser proporcionais à gravidade da situação clínica global e ao prognóstico. Conclusão: esta ferramenta pôde e poderá evitar que pacientes sejam excluídos do acesso aos cuidados de saúde necessários para que suas demandas sejam avaliadas, seu sofrimento diminuído e suas doenças curadas, quando possível.

Em tempos de COVID: A Ciência, a Ética e a Medicina são indissolúveis! E nunca é demais repetir / In times of COVID: Science, Ethics and Medicine are indissoluble! And it never hurts to repeat

A pandemia provocada pelo vírus Sars-CoV-2 não só aproximou o público leigo do meio acadêmico-médico, mas também pressionou médicos, pesquisadores e estadistas por resultados rápidos a fim de contê-la. É nesse ambiente de incerteza e necessidade de produção cientifica rápida, que devemos lembrar que o progresso não é a qualquer custo, deve-se agir com cautela, afinal a Ciência, a Ética e a Medicina são indissolúveis!

The pandemic caused by the Sars-CoV-2 virus not only brought the lay public closer to the academic-medical environment, but also put pressure on doctors, researchers and statesmen for quick results in order to contain it. It is in this environment of uncertainty and the need for rapid scientific production, that we must remember that progress is not at any cost, one must act with caution, after all Science, Ethics and Medicine are indissoluble!

Recomendações para o manejo de dispositivos cardíacos eletrônicos implantáveis post mortem / Recommendations for the post-mortem management of cardiac implantable electronic devices

O manejo de dispositivos cardíacos eletrônicos implantáveis de pacientes que evoluem a óbito tem sido motivo de controvérsia. Em nosso meio, não há recomendações uniformes, estando baseadas exclusivamente em protocolos institucionais e em costumes regionais. Quando o cadáver é submetido para cremação, além de outros cuidados, recomenda-se a retirada do dispositivo devido ao risco de explosão e dano do equipamento crematório. Principalmente no contexto da pandemia causada pelo SARS-Cov-2, a orientação e organização de unidades hospitalares e serviços funerários é imprescindível para minimizar o fluxo de pessoas em contato com fluidos corporais de indivíduos falecidos por COVID-19. Nesse sentido, a Sociedade Brasileira de Arritmias Cardíacas elaborou este documento com orientações práticas, tendo como base publicações internacionais e recomendação emitida pelo Conselho Federal de Medicina do Brasil.

The management of cardiac implantable electronic devices after death has become a source of controversy. There are no uniform recommendations for such management in Brazil; practices rely exclusively on institutional protocols and regional custom. When the cadaver is sent for cremation, it is recommended to remove the device due to the risk of explosion and damage to crematorium equipment, in addition to other precautions. Especially in the context of the SARS-CoV-2 pandemic, proper guidance and organization of hospital mortuary facilities and funeral services is essential to minimize the flow of people in contact with bodily fluids from individuals who have died with COVID-19. In this context, the Brazilian Society of Cardiac Arrhythmias has prepared this document with practical guidelines, based on international publications and a recommendation issued by the Brazilian Federal Medical Council.

Aproximaciones a las practicas de terapia ocupacional y su relación con algunos principios éticos de los derechos humanos / Aproximações às práticas da terapia ocupacional e sua relação com alguns princípios éticos dos direitos humanos / Approaches to the practices of occupational therapy and its relationship with some human rights ethical principles

Resumen Este artículo presenta los principales resultados de un estudio cuyo objetivo fue analizar la relación entre las prácticas de Terapia Ocupacional y tres de los principios éticos o valores de los Derechos Humanos: autonomía, dignidad e igualdad, a partir de la experiencia de los y las terapeutas ocupacionales de la ciudad de Concepción en Chile. La metodología de investigación utilizada es cualitativa, con un enfoque hermenéutico dialéctico. Participaron en el estudio once terapeutas ocupacionales de ambos sexos. Los cuales se desempeñan en el ámbito de la salud, educación y justicia. La información se produjo realizando entrevistas semiestructuradas a dos de ellos, y en un grupo de discusión en el cual participaron nueve terapeutas ocupacionales. Las categorías se analizaron a través de análisis del discurso. Los resultados principales indican que los facilitadores para materializar los principios éticos de los derechos humanos se encuentran en la intencionalidad y el desarrollo incipiente de la conciencia ocupacional a nivel disciplinar. La mayor dificultad se encuentra en las condiciones materiales y simbólicas que genera el modelo capitalista neoliberal en los espacios institucionales de prácticas. El desafío es promover la asociatividad entre los actores involucrados en los procesos de intervención, así como fomentar el rescate de valores colectivos en las prácticas disciplinares.

Resumo Este artigo apresenta os principais resultados de um estudo cujo objetivo foi analisar a relação entre as práticas da Terapia Ocupacional e três dos princípios éticos ou valores dos Direitos Humanos: autonomia, dignidade e igualdade, com base na experiência de terapeutas ocupacionais da cidade de Concepción, no Chile. A metodologia de pesquisa utilizada foi qualitativa, com abordagem hermenêutica dialética. Onze terapeutas ocupacionais de ambos os sexos participaram do estudo, os quais trabalham no campo da saúde, educação e justiça. As informações foram produzidas por entrevistas semiestruturadas para duas delas e em um grupo de discussão no qual participaram nove terapeutas ocupacionais. As categorias foram analisadas por meio da análise do discurso. Os principais resultados indicam que os facilitadores para materializar os princípios éticos dos direitos humanos estão na intencionalidade e no desenvolvimento incipiente da consciência ocupacional no nível disciplinar. A maior dificuldade encontra-se nas condições materiais e simbólicas geradas pelo modelo capitalista neoliberal nas práticas institucionais. O desafio é promover a associatividade entre os atores envolvidos nos processos de intervenção, bem como promover o resgate de valores coletivos em práticas disciplinares.

Abstract This article presents the main results of a study whose objective was to analyze the relationship between Occupational Therapy practices and three of the ethical principles or values ​​of Humans Rights: autonomy, dignity and equality, based on the experience of occupational therapists from the city of Concepción in Chile. The research methodology used is qualitative, with a dialectical hermeneutical approach. Eleven occupational therapists of both genders participated in the study. They work in the field of health, education and justice. The information was produced by semi-structured interviews to two of them, and in a discussion group in which nine occupational therapists participated. The categories were analyzed through discourse analysis. The main results indicate that the facilitators to materialize the ethical principles of human rights are in the intentionality and the incipient development of occupational awareness at the disciplinary level. The greatest difficulty is found in the material and symbolic conditions generated by the neoliberal capitalist model in institutional practices. The challenge is to promote the associativity among the actors involved in the intervention processes, as well as to promote the rescue of collective values in disciplinary practices.

The need to standardize use of the newly deceased in medical trainings

OBJECTIVES: The present study aimed to identify the characteristics of use of the deceased in invasive training and the bioethical principles that govern this practice. In this context, it has become imperative to deduce which professional skills are critical to develop. METHODS: A prospective study investigated a cadaver's use in medical (and related) schools through a questionnaire, which was made available for 48 hours on social networks (Facebook and LinkedIn) to groups of doctors and medical students using a communication app (WhatsApp). The inclusion criteria were being a medical student or a doctor. Cases in which the answers to the questionnaire were inadequate, or when the student had reason to withdraw, were excluded. Each participant could only answer the questionnaire once, and could not modify the responses after submitting it. RESULTS: A disproportionate relationship was found regarding the replacement of the newly deceased by other means (such as dummies and simulators). This outcome suggests that there is no substitution, concomitant with the importance of a prior request for consent from the patient and/or subsequent consent from family members. CONCLUSION: According to the findings, the significance of—and need for—training is undeniable. Hence, it is urgent to normalize the practice and definition of the ethical limitations of medical conduct.

Surgical ethics: a framework for surgeons, patients, and society

Summary The practice of surgery is based on the technical capabilities of the surgeon (techne), their knowledge (episteme) and their capacity of judgment (phronesis). Surgeons face situations that call into question moral choices and face ethical difficulties in their daily practice. In fact, innovation is increasing, and as operations become more complex and the risks become greater, the tools necessary to approach an ethically challenging surgical case become more important. Surgical ethics can be distinguished from other medical ethics fields because of its unique characteristics and goals. Ethics lie at the core of professionalism: a proficient surgeon is considered to be not only competent to perform the art and science of surgery as traditionally understood, but also to be ethically and morally reliable. The principlism and the four-box model approaches to clinical ethics could serve as a guide to the surgical ethics discussion. There are five categories of experience and relationships that are especially important in surgery-rescue, proximity, ordeal, aftermath and presence. Ethical reasoning should help surgeons to gives answers to the questions: What should be done? Has the right decision in this situation been made? The following article is presented with the intent of encouraging thought and dialogue about ethical considerations relevant to the practice of surgery. For that reason, we will first define the scope of surgical ethics, then we will present the main ethical issues faced by surgeons and how surgeons deal with them. Finally, I will show the implications of the development of surgery ethics for patients, surgeons and society.

La responsabilidad: un principio para retomar en la reflexión bioética

La ciencia y su brazo, la tecnología, pueden centrarse en una lógica antropocéntrica en la medida en que se empecinen en satisfacer únicamente las necesidades humanas a expensas del dominio (o destrucción) de la naturaleza y las especies coexistentes. También es posible que se pongan al servicio de poderes económicos y políticos y se investigue únicamente bajo una lógica centrada en la ganancia. En medio de este panorama, se hace un llamado a un acto de conciencia para retomar la propuesta del filósofo alemán Hans Jonas sobre el principio de responsabilidad, según el cual, es necesaria una reflexión más allá de las relaciones inmediatas, que incluya a la naturaleza, los animales y las generaciones futuras en la formulación de una nueva ética que debe enseñarse y practicarse desde la academia.

SUMMARY Science and its arm, technology, may focus on an anthropocentric logic if they insist on satisfying only human needs at the expense of the mastery (or destruction) of nature and coexisting species. It is also possible that they serve to economic and political powers and investigate only under a logic focused on profit. Within this panorama, a call is made to an act of conscience for the proposal of the German philosopher Hans Jonas on responsibility principle, which claims for a reflection beyond the immediate relations, including nature, animals and future generations in the formulation of a new ethics that should be taught and practiced from the academy.

¿Responde la Resolución 8430 de 1993 a las necesidades actuales de la ética de la investigación en salud con seres humanos en Colombia? / Does Resolution 8430 of 1993 respond to the current needs of ethics in health research with human beings in Colombia?

Resumen La verificación del cumplimiento de los principios éticos en la investigación en salud legitima su ejercicio ante la sociedad y posibilita la resolución de dilemas éticos frente a nuevos intereses y métodos de investigación. En Colombia, la Resolución 8430 de 1993 es una de las principales pautas éticas que regulan la investigación en salud. Dado que no ha sido revisada ni actualizada desde su adopción, se hace necesario valorar su vigencia y suficiencia para abordar los potenciales dilemas éticos que se plantean actualmente en la investigación en salud en el país. En este contexto, se detallan algunos vacíos y contradicciones, así como aspectos que requieren de una revisión profunda, a partir de una concepción amplia de las áreas y los métodos de investigación en salud. Tras discutir las principales falencias e imprecisiones, se proponen alternativas para que la Resolución responda a las necesidades actuales del país frente a la ética en investigación en salud con seres humanos.

Abstract Verifying the compliance with the ethical principles of health research legitimizes its exercise in the eyes of the society and allows for the resolution of ethical dilemmas that emerge from new research interests and methods. Resolution 8430 of 1993 is one of the main ethical guidelines governing health research on human beings in Colombia. Considering that the resolution has not been revised or updated since its promulgation it becomes necessary to evaluate its current validity and adequacy to address the potential ethical dilemmas in the existing country's health research. Some gaps, contradictions, and aspects that require a deep review are detailed in this paper from a wide conception of health research areas and methods. After discussing the main weaknesses and inaccuracies, some alternatives are proposed to adjust the resolution to the present needs in health research with human beings.

Aproximaciones bioéticas al caso de Charlie Gard / Aproximações bioéticas ao caso de Charlie Gard / Bioethical approximations to the case of Charlie Gard

Resumen: El litigio que enfrentó a los padres del niño Charlie Gard contra el Great Ormond Street Hospital de Londres, primero, y contra el propio Reino Unido, después, generó efectos mediáticos a nivel mundial pero escaso debate desde la perspectiva bioética. En el presente artículo se resumen algunos aspectos relevantes de la controversia que permiten analizar tres de las lecciones formuladas por Wilkinson y Savulescu al respecto. Se plantean además dos reflexiones bioéticas: la primera en relación a la dificultad en la aplicación de principios para examinar el caso, y la segunda referida a la interdisciplinariedad requerida para su análisis.

Resumo: O litigio que enfrentou os pais do menino Charlie Gard contra o Great Ormond Street Hospital de Londres, primeiro contra o próprio Reino Unido, gerou depois efeitos midiáticos mundiais porém escasso debate sob uma perspectiva bioética. No presente artigo se resume alguns aspectos relevantes da controvérsia, que permitem analisar três das lições formuladas por Wilkinson e Savulescu a respeito. Além disto, se propõe duas reflexões bioéticas: a primeira em relação à dificuldade na aplicação de princípios para examinar o caso e a segunda no que se refere à interdisciplinaridade requerida para sua análise.

Abstract: The litigation that confronted the parents of the child Charlie Gard against the Great Ormond Street Hospital in London, first, and against the United Kingdom itself, later, generated media effects worldwide but little debate from a bioethical perspective. This article summarizes some relevant aspects of the controversy that allow analyzing three of the lessons formulated by Wilkinson and Savulescu in this regard. Two bioethical reflections are also proposed: the first in relation to the difficulty in the application of principles to examine the case, and the second referred to the interdisciplinarity required for its analysis.

Vulnerabilidade social diante da fosfoetanolamina a partir da teoria principialista / Social vulnerability to phosphoethanolamine based on the principlist theory / Vulnerabilidad social frente a la fosfoetanolamina a partir de la teoría principialista

Resumo No Brasil, a difusão de informações acerca da promessa de cura do câncer com fosfoetanolamina, observada em alguns estudos em modelos experimentais, contribuiu para que indivíduos enfermos procurassem tratamento com essa droga, mesmo sem a realização de ensaios clínicos em humanos. Este trabalho tem por objetivo analisar, a partir de revisão sistemática da literatura e segundo os parâmetros da teoria principialista e a concepção de vulnerabilidade social, o uso da fosfoetanolamina como abordagem terapêutica para o tratamento do câncer na população brasileira.

Abstract In Brazil, the dissemination of information regarding the promise of a cancer cure using phosphoethanolamine, observed in some in experimental model studies, has contributed to ill individuals seeking treatment with this drug, even without human clinical trials. This work aims to analyze the use of phosphoethanolamine as a therapeutic approach for the treatment of cancer in the Brazilian population, based on a systematic review of the literature and according to the parameters of the principlist theory and the concept of social vulnerability.

Resumen En Brasil, la difusión de informaciones acerca de la promesa de cura del cáncer con fosfoetanolamina, observada en algunos estudios en modelos experimentales, contribuyó a que los individuos enfermos buscaran tratamiento con esta droga, incluso sin la realización de ensayos clínicos en humanos. Este trabajo tiene por objetivo analizar, a partir de una revisión sistemática de la literatura y según los parámetros de la teoría principialista y la concepción de vulnerabilidad social, el uso de la fosfoetanolamina como abordaje terapéutico para el tratamiento del cáncer en la población brasileña.