¿Quién juzga la actuación médica? / Who judges medical practice?

Resumen Las demandas judiciales por la percepción del paciente de una actuación médica inadecuada son una realidad creciente en la práctica médica, la cual entraña una preocupación extendida en el gremio médico. Las demandas judiciales frecuentemente conllevan circunstancias adicionales a la primaria preocupación de prevenir o sancionar actos de negligencia médica. CETREMI emite algunas recomendaciones a los profesionales jurídicos y médicos para mejorar esta situación y evitar daños en la relación médico-paciente.

Abstract Lawsuits due to patient perception of inappropriate medical actions are a growing reality in medical practice, which entails widespread concern in the medical community. Lawsuits often entail additional circumstances beyond the primary concern of preventing or sanctioning acts of medical negligence. CETREMI proposes various recommendations aimed at legal and medical professionals to improve this circumstance and avoid harming the doctor-patient relationship.

Medical errors, medical negligence and defensive medicine: A narrative review

Abstract Error in medicine and medical liability has a long history dating back to Antiquity. During the 19th Century, most lawsuits related to errors in treating surgical problems were settled. However, in the first half of the 20th Century, lawsuits claimed that mistakes were related to the doctor's action: the doctor made something wrong (errors of commission). In Brazil, medical error is defined as inappropriate conduct, including negligence and recklessness, that causes harm to the patient. The physician's fear of being suited is the reason for some practice named defensive Medicine (D.M.), defined as ordering unnecessary tests and procedures or avoiding treatments for patients considered at high-risk. Thus, this narrative review aims to analyze and describe the relationship between medical errors, medical negligence, and the practice of D.M. So, the authors propose procedures and attitudes to avoid medical errors and the approach of D.M.: a national focus to create leadership and research tools to enhance the knowledge base about patient safety; a reporting system that would help to identify and learn from errors; the use of a computer-based protocol reminder; some technological devices to help the medical practice (electronic prescribing and information technology systems); creating risk management programs in hospitals. Therefore, the authors conclude that the most critical attitude to avoid medical liability is a good and ethical medical practice with the proper use of technology, based on knowledge of scientific evidence and ethical principles of medicine - for the benefit of patients. HIGHLIGHTS This article defines medical errors and medical responsibility from a Brazilian perspective. This article calls attention to the risks of medical liability and the unethical use of defensive medicine. The authors propose some procedures and attitudes to avoid medical errors like the use of technology at the bedside and computer-based protocols. The authors state that a good and ethical medical practice can avoid medical liability.

La mediación sanitaria en Chile / Medical mediation in the international context

Mediation can approximate opposing positions and reach agreements that offer viable solutions for the problems posed by parties. The favorable results, the statements of the professionals and the welfare of the parties who participate in it are some of the reasons for its growth. Its fields of action are diverse, creating a space where the protagonists solve their problems and transform their relationships without having to resort to lengthy and costly legal processes to reach valid agreements. Mediation allows to dejudicialize health care and improve the relationships that are created in all its services. Its implantation in health organizations will favor a more humanized attention by eliminating conflicts, thus elevating the quality and degree of well-being of all the professionals who participate.

Mediación en el sistema público de salud: oportunidades para mejorar / Mediation in public healthcare: opportunities for improvement

Background: Mediation in healthcare is a non-adversarial process to resolve a dispute risen between patients and health providers during medical attention Aim: To characterize the mediation process taking place in the public health system in Chile, from its start until 2017. Material and Methods: Cross-sectional descriptive study. Under the Transparency Law, information about mediation processes between 2005 and 2017 was requested to the State Defense Council (CDE in its Spanish acronym). This data was complemented with the information available on the website of this agency. Results: Ninety four percent of the complaints filed at the CDE were deemed eligible for mediation. Only 19% of the concluded cases led to an agreement between the disputing parties. The agreements reached were mostly monetary compensation, medical assistance, and apologies/explanation of the facts. The average amount of compensation reached $14,862,088 (Chilean pesos). The most commonly claimed damage resulting from medical care was partial disability. The medical specialties more often claimed were Obstetrics and Gynecology, General Surgery, and Internal Medicine. Conclusions: The analysis of conducted mediations is a source of feedback for healthcare staff and health institutions. It would greatly contribute to prevent possible damage and medical conflicts, specially within the specialties with the most complaints. Improvements to the existing legislation are required to ensure free access for all the population.

Pretention of Defensive Medicine in Rehabilitation for Stroke / 中国康复理论与实践

Objective:To investigate the defensive medicine of physicians in the process of rehabilitation. Methods:Defensive medicine were investigated from the medical records of 220 inpatients included in the clinical pathway of stroke rehabilitation from January, 2016 to January, 2018. Results:There might be some defensive medicine behaviours for diagnosis, treatment, prevention of medical tangle, etc., in stroke rehabilitation. Conclusion:It is needed to reduce defensive medicine in various ways.

A descriptive study of the effect of a disciplinary proceeding decision on medical practitioners' practice behaviour in the context of providing a hydrocortisone and lignocaine injection

INTRODUCTION@#We conducted a descriptive study to evaluate any changes in practice behaviour regarding the provision of hydrocortisone and lignocaine (H&L) injections among doctors and how an H&L injection is priced following a disciplinary proceeding decision. A doctor had been fined SGD 100,000 for failing to obtain informed consent before an H&L injection.@*METHODS@#We performed a survey shortly after the disciplinary decision to ascertain: (a) the category of the respondent; (b) whether the respondent provided H&L injections and how much he charged before the decision; and (c) after the decision. All members of the Singapore Medical Association and College of Family Physicians Singapore are doctors and were invited to participate.@*RESULTS@#1,927 doctors responded to the survey. Prior to the decision, 804 doctors did not perform H&L injections; this increased by 20.4% to 968 after the decision. The number of doctors who gave H&L injections decreased by 164 (14.6%), from the previous 1,123. Pre-decision, doctors who determined their own price for H&L injections charged a median pricing ≤ SGD 100. Post-decision, the median charge rose to > SGD 100 to SGD 200. At higher price bands, the number of doctors who charged > SGD 1,000 increased eight-fold, from eight to 65.@*CONCLUSION@#The study demonstrated how a disciplinary decision can affect practice behaviour, and specifically how doctors may choose to not offer a service, an example of defensive medicine through avoidance behaviour. It also showed how prices for a service can rise following such a decision, which demonstrates the concept of negative general deterrence in sentencing.

Medicina defensiva: uma prática em defesa de quem? / Defensive medicine: a practice in whose defense? / Medicina defensiva: ¿una práctica en defensa de quién?

Resumo Casos de litígio contra médicos têm aumentado no Brasil: já são três novas ações por hora em decorrência de suposto erro médico. Este estudo objetivou analisar se o médico processado e o profissional que conhece outro colega de profissão que também passou por tal situação alteram a conduta clínica com receio de figurar como réu em ação indenizatória por erro médico. Foi aplicado questionário a 104 médicos de 28 especialidades, 53 mulheres (51%) e 51 homens (49%). Analisou-se a relação entre variáveis como estado civil, tempo médio de formado, vínculos empregatícios, entre outras, e a prática cotidiana da medicina defensiva. O estudo busca promover o debate sobre a alteração da conduta clínica por interesse do médico em não ser processado, desvinculando sua prática e a hipótese diagnóstica do paciente.

Abstract Cases of litigation against physicians have been growing in Brazil: there are currently three new lawsuits filed per hour related to alleged medical error. The purpose of this study was to analyze if both the physician who is sued and the physician who knows another physician who has been sued change their clinical behavior due to the fear of appearing as a defendant in a lawsuit seeking compensation for medical error. In all, 104 questionnaires were answered by physicians of 28 different specialties, 53 (51%) being women and 51 (49%) being men. The relationship between variables such as marital status, the average time since graduation, employment links, among others, and the daily practice of defensive medicine. The study aims to promote the debate about the change in clinical behavior due to the physician's interest in not being sued by removing the link between their conduct and the patient's diagnostic hypothesis.

Resumen Los casos de litigio contra médicos han aumentado en Brasil: ya son tres nuevas acciones por hora, como consecuencia de un supuesto error médico. Este estudio tuvo como objetivo analizar si el médico procesado y el profesional que conoce a otro colega de profesión que pasó por tal situación modifican su conducta clínica ante el temor de figurar como reo en una acción indemnizatoria por error médico. Se aplicó un cuestionario a 104 médicos de 28 especialidades, siendo 53 mujeres (51%) y 51 hombres (49%). Se analizó la relación entre variables como estado civil, tiempo promedio de egreso, vínculos laborales, entre otras, y la práctica cotidiana de la medicina defensiva. El estudio procura promover el debate sobre la alteración de la conducta clínica por interés del médico en no ser procesado, desvinculando su práctica y la hipótesis diagnóstica del paciente.

Responsabilidad Médica en Chile: Fallos de la Corte Suprema de Justicia 2017 / Medical Malpractice in Chile: Rulings of the Supreme Court of Justice 2017

RESUMEN: El objetivo de este trabajo fue analizar los datos epidemiológicos y jurídicos de los casos por responsabilidad médica fallados por la Corte Suprema de Justicia chilena (CSJ) el año 2017, para relevar los escenarios de alto riesgo, aportando a su prevención. Se realizó un estudio retrospectivo, revisando los fallos de la CSJ en la base de datos electrónica del Poder Judicial chileno. Se seleccionaron y analizaron los fallos por responsabilidad médica. Se detectó un total de 61 casos por responsabilidad médica que alcanzaron la CSJ en 2017. Todos correspondieron a causas civiles. La duración promedio de los juicios fue 41,9 meses. La especialidad más demandada y condenada fue ginecología. La mayoría de las demandas y condenas afectó al Sistema Público de salud. Los casos que dan origen a las demandas son, en su mayoría, de atención de urgencias por sobre las programadas, y de tratamiento por sobre procedimientos quirúrgicos. El 54,8 % de los casos resultaron en la muerte del paciente. La mitad de los fallos condenatorios involucraba el fallecimiento del usuario afectado. Se deben investigar los factores de riesgo no sólo de la ocurrencia de mal-praxis, si no de la judicialización de los conflictos médico-paciente, especialmente en el área gineco-obstétrica, incluyendo los casos de instancias anteriores a la CSJ. Se debe investigar así mismo los factores de riesgo para la mayor propensión de los profesionales de sexo masculino de ser demandados y condenados por malpraxis médica.

ABSTRACT: The objective of the present study is to characterize the epidemiologic and juridical data for medical malpractice cases ruled by the Chilean Supreme Court (CSC) in 2017, to highlight the high risk scenarios, as a contribution to their prevention. A search of the CSC electronic database was conducted to identify and analyze CSC rulings for medical malpractice cases. In this study 61 malpractice cases ruled by CSC were identified. The CSC received only civil cases of medical malpractices during the studied period. The average duration of the trial was 41.9 months. Gynecologists faced suits and received sentences more frequently than any other type of specialist. The majority of prosecuted cases and convictions were associated with the public health system. A greater number of claims were related to emergency care than with scheduled procedures. Likewise, more claims were associated with non-surgical treatment than with surgical procedures. 54.8 % of all cases resulted in the patient's death. Half of the cases that lead to conviction, were related to the death of a patient. Risk factors should be investigated, not only of the occurrence of malpractice, but also of the judicial process of doctor-patient conflicts, especially in the obstetrics and gynecology area, including the analysis of cases of prior judicial instances. The risk factors for the higher propensity of male professionals to be prosecuted and convicted for medical malpractice should also be investigated.

Medicina defensiva en Servicios de Urgencias del Hospital Central del Instituto de Previsión Social

RESUMEN Objetivo: determinar el grado de medicina defensiva que se practica en los Servicios de Urgencias del Hospital Central del Instituto de Previsión Social, Asunción-Paraguay. Métodos: se administró un cuestionario de autoevaluación de tipo Likert validado, a los médicos de atención de emergencia; se exploraron variables relacionadas al sexo, edad, especialización, años de práctica, antecedentes legales previos y turnos de trabajo. Resultados: se evaluó a 220 médicos de 8 Servicios de Urgencias, el 82% practicaba medicina defensiva. Los médicos varones mostraron un comportamiento más defensivo (p=0,1). Emergentología, Traumatología y Ortopedia fueron las especialidades con mayor práctica de medicina defensiva (100%). Ginecología y Obstetricia tuvo el mayor número de demandas. Conclusión: la medicina defensiva se presenta en un alto porcentaje en los Servicios de Urgencias pues 82% de los médicos practican algún grado de la misma, siendo mayor en varones y en las especialidades Emergentología y Traumatología y Ortopedia

ABSTRACT Objective: To determine the degree of defensive medicine practiced in the Emergency Services of the Hospital Central of the Instituto de Previsión Social, Asunción-Paraguay. Methods: A validated Likert-type self-assessment questionnaire was administered to emergency care physicians. Variables related to sex, age, specialization, years of practice, previous legal background and work shifts were explored. Results: Two hundred and twenty physicians from eight Emergency Services were evaluated, 82% practiced defensive medicine. The male doctors showed a more defensive behavior (p=0.1). Emergentology, Traumatology and Orthopedics were the specialties with the highest practice of defensive medicine (100%). Gynecology and Obstetrics had the highest number of demands. Conclusion: Defensive medicine is presented in a high percentage in the Emergency Services because 82% of doctors practice some degree of it, being higher in males and in the specialties Emergentology, Traumatology and Orthopedics

Entendimento do Tribunal de Justiça do Pará sobre o erro médico na esfera penal / Understanding of the Court of Justice of Pará on medical error in the criminal sphere

INTRODUÇÃO: O processo por erro médico costuma ter impacto profundo tanto na vida profissional como na vida pessoal do médico. Entretanto, como a judicialização da medicina é recente, carece de estudos com análise dos fatos a partir da dupla perspectiva da Medicina e do Direito. OBJETIVO: Analisar os processos da esfera penal do Tribunal de Justiça do Pará. MÉTODOS: Foi realizada uma pesquisa por palavra-chave no site do Tribunal de Justiça do Estado do Pará (TJPA) com o termo de pesquisa: "erro médico". RESULTADOS: Foram encontrados 42 julgados jurisprudenciais. Desses, 24 foram excluídos, pois: 4 eram repetições; 19 eram crimes não cometidos por médicos e 1 por tratar de difamação. Ocorreu uma prescrição e três processos ainda não haviam sido julgados na primeira instância. Dos 14 processos julgados, houve 6 condenações e 8 absolvições. A distribuição por especialidades se deu da seguinte maneira: 8 na ginecologia-obstetrícia (GO); 4 na emergência clínica; 2 na cirurgia geral; 1 em anestesiologia/cirurgia plástica; 1 em oftalmologia; 1 em ortopedia; e 1 em radiologia. CONCLUSÃO: Os casos de acusação de supostos erros cometidos por médicos no exercício de suas especialidades ainda são raros no panorama geral do Pará. As especialidades ligadas à cirurgia e às situações de emergência, principalmente GO, foram as principais envolvidas nesse tipo de processo.

INTRODUCTION: The medical error process usually has a profound impact on both professional and personal life of the doctor.However, since the judicialization of medicine is recent, there is a need to study the facts from the dual perspective of medicine and law. OBJECTIVE: To analyze the criminal proceedings of the Pará Court of Justice. METHODS: A keyword search was performed on the website of the Court of Justice of the State of Pará (TJPA) with the search term: "medical error". RESULTS: Forty-two sentences were found. Of these, 24 were excluded because: four were repetitions; 19 were crimes not committed by doctors and one was defamation. In addition, one prescription occurred and three cases had not yet been tried at first instance.Of the 14 lawsuits judged, there were six convictions and eight acquittals. The distribution by specialties was as follows: eight cases in obstetrics/gynechology (Ob-Gyn); four in clinical emergency; two in general surgery; one in anesthesiology/plastic surgery; one in ophthalmology; one in orthopedics; and one in radiology. CONCLUSION: The cases of accusation of alleged errors committed by doctors in the exercise of their specialties are still rare in the state of Pará. Specialties related to surgery and emergency situations, especially Ob-Gyn, seem to be the main ones involved in this type of process.

Exploration and research on application of resident doctors of emergency medicine specialty in clinical decision-making method / 重庆医学

Objective To discuss the current status of application of the four kinds of clinical decision‐making method (mode recognition method ,hypothesis deductive method ,event‐driven method and applying regulation method ) in the clinical practice of the emergency resident doctors and to understand their mastery situation of the clinical decision‐making methods and the influencing factors .Methods One thousand and thirty‐five patients collected by 207 resident doctors (5 cases were randomly collected from the patients diagnosed and treated by each resident doctor ) were divided into 3 groups according to different year systems .The clinical decision‐making methods ,diagnosis accuracy of different clinical decision‐making methods and the influencing factors of decision‐making methods were compared among different grades .Results The difference in the decision‐making methods among different year systems had statistical significance (P<0 .05);furthermore ,the difference in the diagnostic accuracy among different decision‐making methods had statistical significance (P< 0 .05) ,the differences in the defensive behaviors and different decision‐making methods were statistically significant (P<0 .05) ,the multi‐classification Logistic regression of different decision‐making methods showed that the differences in the different residency year system ,residency education ,residency clinical contacting time ,inpatient symptoms ,defensive behaviors and interrogation reliability degree had statistical significance (P< 0 .05) .Conclusion The most commonly used decision‐making method by the resident doctors is the applying regulation method .The residency year system ,resi‐dency education ,residency clinical contacting time ,inpatient symptoms ,defensive behaviors and interrogation reliability degree are the influencing factors of application of the clinical decision‐making methods in the clinical practice of the emergency medicine spe‐cialty .

Defensive medicine and its contributing factors of public hospitals in China:Research findings from a physician survey in a city of Guangdong province / 中国卫生政策研究

The rapid cost escalation and vast supplier-induced demands in the Chinese health care system are well-known to the health policy research community. The existing literature tends to explain the pervasive overprovision of care by financial incentives of hospitals and physicians. Behind this is a series of misaligned perverse incentives embedded in the Chinese health system for decades. With a survey of public hospital physicians in a city of Guangdong, this study re-veals that the overprovision of care, especially overprescription, is not solely driven by economic incentives, but also by physicians’ motive of avoiding potential disputes with patients, reflecting defensive medical behaviors. The survey was con-ducted in December 2013, which selected 504 licensed physicians by random sampling. The regression analysis suggests that low income and the perceived imbalance between efforts and rewards indeed contribute to physicians’ motivation of de-fensive medicine. In the meantime, their past experiences of medical disputes with patients are also found significantly as-sociated with defensive behaviors. This study has revealed the critical impacts of the escalating tension between doctors and patients in distorting physician’ behaviors, and lays out policy recommendations.

Medicina defensiva: uma prática necessária? / Defensive medicine: a necessary practice?

O artigo em questão aborda os motivos pelos quais a Medicina Defensiva é largamente utilizada no Brasil e no Mundo. A Medicina Defensiva, na prática, se caracteriza pela utilização exagerada de exames complementares, pelo uso de procedimentos terapêuticos supostamente mais seguros, pelo encaminhamento frequente de pacientes a outros especialistas e pela recusa ao atendimento de pacientes graves e com maior potencial de complicações. Trata-se de uma prática que tem como objetivo principal defender o médico de eventuais processos, principalmente na área judicial. A maneira como são conduzidos os processos pelo poder judiciário certamente contribui para a consolidação desta prática insensata. A morosidade da justiça, em nosso meio, associado ao despreparo dos juízes e peritos judiciais na análise dos casos, leva a um desgaste emocional das partes. Alem disso, a formação precária do médico em nosso país faz com que se utilize de meios requintados de diagnóstico e tratamento em detrimento a um exame clínico pormenorizado e uma adequada comunicação com o paciente. Além de ineficiente em proteger o médico, a Medicina Defensiva traz consequências graves ao paciente e à sociedade, já que gera um custo adicional incalculável ao exercício da Medicina, determina um maior sofrimento ao doente e faz com que haja uma deteriorização na relação médico-paciente, que sempre foi pautada pela confiança, respeito e pessoalidade.

We discuss the reasons why Defensive Medicine is widely used in Brazil and worldwide. The Defensive Medicine is characterized by excessive use of complementary tests, the use of supposedly safer therapeutic procedures, the frequent referral of patients to other specialists and by the refusal to care for critically ill patients and with greater potential for complications. This is a practice that aims to defend the doctor from legal suits. The way the processes are conducted by the judiciary certainly contributes to the consolidation of this foolish practice. The slow pace of justice in our country, associated with the unpreparedness of judges and legal experts in the analysis of cases, leads to an emotional exhaustion of the parties involved. Furthermore, poor training of doctors in our country values the use of sophisticated diagnostic and treatment methods, rather than a thorough clinical examination and appropriate communication with the patient. Besides inefficient in protecting the doctor, Defensive Medicine has severe consequences to the patient and to society, since it generates an additional invaluable cost to medical practice, determines greater suffering to the patient and causes deterioration of the doctor-patient relationship, which has always been marked by trust, respect and personhood.

Error y medicina a la defensiva: ética médica y la seguridad del paciente / Erro e medicina defensiva: ética médica e a segurança do paciente / Error and defensive medicine: medical ethics in patient?s safety

Baseando-se no imperativo ético da medicina, primun non nocere, este artigo apresenta considerações sobre o erro médico e a prática da medicina defensiva, cujo propósito principal parece, nuitas vezes, estar vinculado à proteção do profissional, em detrimento dos interesses do paciente. A partir de estudos realizados nos Estados Unidos se desenvolve uma reflexão sobre tal vinculação eos chamados ?pactos de silêncio?, que acabam gerando na sociedade, em geral, incerteza e desconfiança no que se refere à relação médico-paciente. Conforme os resultados da citada pesquisa, este artigo conclui considerando que ocultar o erro não resolve esta complexa problemática e pode trazer consequências nefastas à prática da medicina, relacionadas ao crescimento dos pedidos de exames, que produzem aumento nos custos da saúde, assim como dificultam o acesso aos serviços. Considera, ademais, que o Estado não pode estar ausente nesta discussão fundamental.

Basándose en el imperativo ético de la medicina, primun non nocere, este artículo presenta consideraciones de ética médica, enfocando el error médico y la práctica de la medicina defensiva, cuyo propósito principal parece muchas veces estar vinculado a la protección del profesional, endetrimento de los intereses del paciente. A partir de estudios realizados en los Estados Unidos se desarrolla una reflexión sobre tal vinculación y los llamados ?pactos de silencio?, que acaban generando incerteza y desconfianza en lo referente a la relación médico-paciente, en la sociedaden general. Conforme a los resultados de la citada pesquisa, concluye considerando que ocultar el error no resuelve esta compleja problemática y puede traer consecuencias nefastas a la práctica de la medicina relacionadas al crecimiento de los pedidos de exámenes, que producen aumento en los costes de la salud así como dificultan el acceso a los servicios. Considera, además, que el Estado no puede estar ausente en esta discusión fundamental.

Based on the ethical imperative of Medicine?s, primun non nocere, this article presents consideration of medical ethics foucusing on error and the pratice of defensive medicine, whose main purpose seems often to be linked to the protection of professional to the detriment of the patient?s interest. It is developed, from studies undertaken in the United States, a reflection on such linkage and the so-called ?pacts of silence?, which end by generating uncertainties and mistrust regarding physician-patient relationship in society at large. In consonance to the above mention research, I concluded by considering that hiding a medical error does not solve this complex problematic, and it may have mean consequences to medical practices related to increasing exams requests that produce increase in health costs as well as hampers access to services. It considers, additionally, that the State cannot be absent in this crucial discussion.

Social recognition of medical accident

There has been a great deal of concern about medical malpractice in Korea. Exact figures are difficult to determine, but medical accidents or disputes have increased since the late 1980's. Since 1988, there have been various legislative attempts to pass the 'Medical Dispute Adjustment Act', a kind of alternative dispute resolution. Finally, in March 2011, the mediation law was enacted. The purpose of this law is to create a rapid, efficient recovery system for patients, and to provide a safe, stable environment for medical personnel. Even though medical accidents are inevitable, like other accidents, of course neither doctors nor patients wish for them to occur. However, the medical system lacks an alternative solution for promoting a rational process for communication about medical accidents. As a result, violence against doctors and occupation of medical institutions are more common than they could be. Meanwhile, the Supreme Court has alleviated the burden of proof in medical disputes by applying the theory of prima facie evidence to protect the rights of patients. Though the Supreme Court's position is reasonable in terms of patient care, these cases could lead to 'defensive medicine'. This phrase refers to treatments motivated more by the reduction of liability than by medical needs. This means an increase in health care costs. Above all, civil litigation requires a great deal of time for both parties. Consequently, if medical accidents are inevitable, medical personnel should respond proactively to accidents rather than concealing them. The social recognition of medical malpractice must change in order to create an effective adjustment system and prevent as many medical accidents as possible.

O consentimento informado para além da medicina defensiva / The informed consent beyond the defensive medicine

O consentimento informado é uma exigência ética e legal na assistência médica. Na perspectiva da Medicina Defensiva, o consentimento informado é visto como documento que visa a proteger os interesses do médico. Na perspectiva da Bioética, é um processo que visa a proteger os interesses do paciente. Numa visão jurídica fundamentada na Bioética, conclui-se que o consentimento informado é processo, que pode ser expresso na forma escrita, que visa proteger interesses tanto de médicos quanto de pacientes.

The informed consent is a legal and ethical requirement in medical care. In the perspective of Defensive Medicine, informed consent is regarded as a document to protect the doctor. On the Bioethics standpoint, informed consent is a process which aims the protection of the patient. In a legal stance based on Bioethics informed consent is a process that can be expressed in written form, to protect both doctors and patients.

Etica en la medicina actual / Ethics in contemporary medicine

El ejercicio de la medicina se ha regido tradicionalmente por los principios de la ética médica y los aspectos científicos que la definen. Sin embargo, la medicina actual se ve fuertemente influida por aspectos de otra índole como el interés económico, el encarnizamiento terapéutico, la medicina defensiva, la cirugía innecesaria, los conflictos de interés, las alteraciones en la aplicación del consentimiento informado, la relación con la industria farmacéutica, el respeto a la confidencialidad, la ética organizacional, y el ejercicio ético que escapa a la voluntad del profesional médico.

Medical practice has been traditionally ruled by the principles of medical ethics and the scientific aspects that define it. However, today's medical practice is largely influenced by other aspects such as: economic interests, abuse of therapeutics, defensive medicine, unnecessary surgeries and conflicts of interests without excluding alterations in the application of the informed consent, the relation with the pharmaceutical industry, respect of confidentiality, organizational ethics, and the ethical practice that escapes the will of the medical professional.

La judicialización del acto médico y la generación de nuevos conflictos / Court intervention in medical decisions and the generation of new conflicts

En las últimas décadas es habitual, también en nuestro país, que muchas decisiones médicas sean sometidas al escrutinio judicial por diversas causas. La diversidad de motivaciones y la extensa temática que abarcan los problemas abordados requieren que cualquier comentario sobre tales procesos judiciales se refiera a la posibilidad de que se provoque un conflicto adicional al que los tribunales teóricamente están llamados a resolver. En este orden de ideas, este trabajo explora las repetidas circunstancias que por falta de normas concretas en el derecho positivo, o por equívocas interpretaciones de la legislación existente o por desconocimiento del progreso científico o de la realidad médica, conducen a la provocación de una medicina defensiva por omisión que resulta gravemente perjudicial para la sociedad. Muchas veces también la exagerada e inexplicable actitud médica temerosa transfiere al tribunal judicial decisiones que son de su exclusiva competencia. Esta conducta contribuye al desmantelamiento de una profesión que, como la médica, ya está sometida a la gravosa situación de diversos sistemas de salud que no cumplen adecuadamente su finalidad de cuidar a la sociedad que los necesita y los mantiene.

In the last decades, medical decisions are increasingly submitted to the courts of law for a number of reasons, also in our country. The various causes and different issues involved in such proceedings require comments referred to the possibility of causing an additional conflict to that which the courts of law are in theory required to address. In that context, this paper explores the repeated cases in which, due to the lack of positive legislation on a given issue, or due to different interpretations of existing legislation, or for lack of understanding of scientific progress or medical facts, defensive medicine finds its way to the detriment of society as a whole. In many other cases, fearful inexplicable attitudes of the doctors involved result in a transfer of exclusively medical decisions to the courts of law. This attitude contributes to the dismantling of a profession such as medicine, which is already subject to the difficult context of a variety of health systems that fail to sufficiently comply with their obligation of taking care of a community that needs and supports them.

Discussion on Status on Disposing Medical Accident and doctors' Defensive Medicine / 中国医学伦理学

After the Statute on Disposing Medical Accident was put in practice,doctors in China are faced with tremendous stress that never faced before.Doctors begin to evade risks with defensive medicine under the stress.There are two types of defensive medicine,one is positive defensive medicine,which will induce to excessive medical treatment for evading risks,another is negative defensive medicine which will lead to nonfeasance in the presence of intensive patients or dangerous diagnosis and treat procedure.Defensive medicine results in inefficiency of medical service and influences patients' safety.How to lessen doctors' defensive medicine will be an important social problem.

The Support of Medical Ethics for Physician-Patient Relationship under Information Asymmetry / 中国医学伦理学

The specialization of medical science determines the objective existence of asymmetric information in medical and health industry.These different understandings in the psychological and behavioral area influenced the development of physician-patient relationship.Medical personnel should look squarely at the professional attributes and dare to play a leading role.Meanwhile,the exchange of the role of patient and medical personnel,understanding patient,clearing of communication channels and enlarging patients′ means of communication will promote harmonious relations between doctors and patients.