Conflictos éticos detectados por psicólogos/as de la atención primaria de salud / Conflitos éticos detectados por psicólogos/as da atenção primária de saúde / Ethical conflicts detected by psychologists of Primary Health Care

Resumen: Objetivo: Identificar la detección de conflictos éticos por parte de los psicólogos/as en el contexto de la atención primaria de salud (APS); determinar su compresión y analizar la descripción de cada uno. Diseño la investigación: Estudio cualitativo, tipo exploratorio-descriptivo. Participantes: 25 psicólogas/os de un universo total de 28 profesionales. Método: El instrumento de recolección de información fue la entrevista semiestructurada, y la técnica de análisis de resultados el análisis narrativo de contenido. Resultados: Los informantes detectan un total de treinta y ocho conflictos éticos claramente diferenciados, argumentando a catorce de ellos como críticos. La categorización permitió diferenciar tres categorías distintas desde las que se establecen y representan: a) atención a consultantes; b) relación entre colegas y con otros profesionales de salud, y c) contexto de trabajo en salud pública. Conclusiones: El estudio permitió acceder a las problemáticas percibidas por los informantes, coincidiendo en que varios de estos conflictos han permanecido naturalizados y normalizados en el tiempo. Surge la necesidad de revisar y visibilizar los cuestionamientos identificados para que establezcan los mínimos necesarios que permitan ser garantes de intervenciones de calidad y excelencia requerida en la salud mental del nivel primario de atención.

Resumo: Objetivo: Identificar a detecção de conflitos éticos por parte dos Psicólogos/as no contexto da APS, determinar sua compreensão e analisar a descrição de cada um. Desenho da pesquisa: Estudo qualitativo, tipo exploratório-descritivo. Participantes: 25 Psicólogos/as, de um universo total de 28 profissionais. Método: O instrumento de coleta de informações foi uma entrevista semiestruturada e a técnica de análise de resultados, a análise narrativa de conteúdo. Resultados: Os informantes detectam um total de trinta e oito conflitos éticos claramente diferenciados, considerando quatorze deles como críticos. A categorização permitiu diferenciar três categorias distintas de onde eles estão estabelecidos e representam: a) atenção a pessoa em consulta; b) relação entre colegas e com outros profissionais da saúde; e c) contexto de trabalho em saúde pública. Conclusões: O estudo permitiu acessar as problemáticas percebidas pelos informantes, coincidindo em que vários destes conflitos permaneceram naturalizados e padronizados no tempo. Surge a necessidade de revisar e visibilizar os questionamentos identificados para que se estabeleçam os padrões* mínimos necessários que permitam ser garantidores de intervenções de qualidade e excelência requeridas na saúde mental do nível primário de atenção.

Abstract: Objectives: To identify the detection of ethical conflicts by psychologists in the context of PHC, determine their understanding and analyze the description of each one. Design: Qualitative study, exploratory-descriptive type. Participants: 25 psychologists, from a total universe of 28 professionals. Method: The data collection instrument was the semi-structured interview and the results analysis technique was the narrative analysis of content. Results: The informants detected a total of thirty-eight clearly differentiated ethical conflicts, arguing fourteen of them as critics. The categorization allowed differentiating three different categories from where they are established and represent: a) attention to consultants; b) relationship between colleagues and with other health professionals; and c) work context in public health. Conclusions The study allowed access to the problems perceived by the informants, agreeing that several of these conflicts have remained naturalized and normalized over time. The need arises to review and make visible the identified questions in order to establish the minimums necessary to be guarantors of quality interventions and excellence required in the mental health of the primary level of care.

Consideraciones del bioderecho sobre la eutanasia en colombia

Este artículo aborda de manera reflexiva las incidencias del bioderecho sobre situaciones de eutanasia en Colombia, al interpretar conflictos morales y jurídicos suscitados por las sentencias de la Corte Constitucional C239 de 1997, T970 de 2014 y la Resolución del Ministerio de Salud y Protección Social 1216, de 2015. El propósito fundamental es el análisis de las decisiones judiciales sobre el final de la vida humana. Por lo tanto, se realiza una revisión de la construcción histórica y jurídica del concepto de eutanasia y se propone la discusión sobre su manejo jurídico y su influencia en el colectivo moral. Asimismo, se diserta sobre el concepto de dignidad humana y muerte digna, como precedentes para dirimir los conflictos éticos que la eutanasia suscita. Al final, se analiza el caso de don Ovidio González, quien se convirtió en 2015 en el primer colombiano en recibir la eutanasia de manera legal dentro del sistema de salud.

This paper reflectively addresses the incidence of bio-law on euthanasia situations in Colombia by interpreting moral and legal disputes arising from the sentences of the Constitutional Court C239 of 1997, T970 of 2014, and Resolution 1216 of the Ministry of Health and Social Protection of 2015. The main purpose is the analysis of judicial decisions regarding the end of human life. A review of the historical and legal construction of the euthanasia concept is done, and a discussion of its legal management and its influence on the moral collective is proposed. The concept of human dignity and dignified death are discussed to solve the ethical conflicts that euthanasia causes. Finally, the case of Ovidio González is analyzed; Mr Gonzalez became the first Colombian to receive euthanasia in a legal way within the health system in 2015.

Este artigo aborda de maneira reflexiva as incidências do Biodireito sobre situações de eutanásia na Colômbia, ao interpretar as disputas morais e legais decorrentes das decisões da Corte Constitucional C239 de 1997 T970 de 2014 e a Resolução do Ministério da Saúde e Proteção Social 1216, de 2015. O objetivo principal é a análise das decisões judiciais sobre o fim da vida humana. Portanto, realiza-se uma revisão da construção histórica e jurídica do conceito de eutanásia e propõe-se a discussão de sua administração legal e sua influência sobre o coletivo moral. Igualmente, expõe-se sobre o conceito de dignidade humana e morte digna, como precedentes para resolver os conflitos éticos que a eutanásia suscita. No final, e analisado o caso de Dom Ovidio González, que em 2015 se tornou o primeiro colombiano a receber a eutanásia legalmente no interior do sistema de saúde.

Perception of and attitude toward ethical issues among Korean occupational physicians

BACKGROUND: Occupational physicians (OPs) have complex relationships with employees, employers, and the general public. OPs may have simultaneous obligations towards third parties, which can lead to variable conflicts of interests. Among the various studies of ethical issues related to OPs, few have focused on the Korean OPs. The aim of the present survey was to investigate the ethical contexts, the practical resolutions, and the ethical principles for the Korean OPs. METHODS: An email with a self-administered questionnaire was sent to members of the Korean Society of Occupational and Environmental Medicine, comprising 150 specialists and 130 residents. The questionnaire was also distributed to 52 specialists and 46 residents who attended the annual meeting of the Korean Association of Occupational and Environmental Clinics in October 2015, and to 240 specialists by uploading the questionnaire to the online community ‘oem-doctors’ in February 2016. The responses to each question (perception of general ethical conflicts, recognition of various ethical codes for OPs, core professional values in ethics of occupational medicine, and a mock case study) were compared between specialists and residents by the chi-squared test and Fisher’s exact test. RESULTS: Responses were received from 80 specialists and 71 residents. Most participants had experienced ethical conflicts at work and felt the need for systematic education and training. OPs suffered the most ethical conflicts in decisions regarding occupational health examination and evaluation for work relatedness. Over 60% of total participants were unaware of the ethical codes of other countries. Participants thought ‘consideration of worker’s health and safety’ (26.0%) and ‘neutrality’ (24.7%) as the prominent ethical values in professionality ofoccupational medicine. In mock cases, participants chose beneficence and justice for fitness for work and confidential information acquired while on duty, and beneficence and respect for autonomy in pre-placement examinations. CONCLUSIONS: This study evaluated the current perception of and attitude toward ethical issues among the Korean OPs. These findings will facilitate the development of a code of ethics and the ethical decision-making program forthe Korean OPs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40557-017-0182-z) contains supplementary material, which is available to authorized users.

Conflictos éticos que se presentan a médicos de tres centros hospitalarios de Bogotá, Colombia / Ethical conflicts presented to doctors in three hospitals in Bogotá, Colombia / Conflitos éticos apresentados aos médicos de três centros hospitalares de Bogotá, Colômbia

La transformación del sistema de salud colombiano a partir de la Ley 100/1993 planteó nuevos conflictos éticos a los médicos. Como parte de una tesis doctoral cuyo objetivo general era comprender las tensiones que emergen entre los tipos de clima ético organizacional y los conflictos éticos que se presentan a médicos y enfermeros en tres instituciones prestadoras de salud (IPS) de Bogotá, se propuso identificar y describir los conflictos éticos que se presentan a los médicos y la manera como los resuelven, para que fuera posible indagar si desde los comités de ética pueden resolverse estos conflictos, como ha sido sugerido por algunos bioeticistas. Para ello se realizaron 23 entrevistas a médicos que laboraban en tres centros hospitalarios con servicios de alta complejidad de Bogotá: uno público, uno privado y uno de un régimen especial. Los resultados sugieren la presencia de conflictos de interés, por una parte, y conflictos de obligación que se expresan como dilemas éticos y angustia moral, por otra. Con base en ello, se formulan recomendaciones para la formación profesional, la investigación y los comités de ética hospitalarios.

The transformation of the Colombian health system from the 100/1993 law raised new ethical conflicts to physicians. As a part of a doctorate thesis oriented to understand emerging tensions among ethical climate and ethical conflicts faced by physicians and nurses in three hospitals located in Bogota, it was proposed to identify and describe the ethical conflicts presented to physicians and the way they are faced. In order to achieve this goal, 23 interviews were carried out with physicians who worked in three hospitals located in Bogota: one private, one public and one with a special regime. The results suggest the presence of interest conflicts on the one hand, and commitment conflicts expressed as ethical dilemmas and moral distress on the other. Based on these results, recommendations to physicians education, research and committees of ethics are suggested.

A transformação do sistema de saúde colombiano a partir da Lei 100/1993 levantou novos conflitos éticos para os médicos. Como parte de uma tese de doutorado cujo objetivo geral foi compreender as tensões que surgem entre os tipos de clima ético organizacional e os conflitos éticos apresentados aos médicos e enfermeiros em três instituições de saúde (IPS) em Bogotá, propôs-se a identificar e descrever os conflitos éticos apresentados aos médicos e como eles os resolvem, para que seja possível pesquisar si a partir dos comitês de ética esses conflitos podem se resolver, como foi sugerido por alguns bioeticistas. Para isso foram realizadas 23 entrevistas com médicos que trabalhavam em três centros hospitalares com serviços de alta complexidade de Bogotá: um público, um privado e um de regime especial. Os resultados sugerem da presença de conflitos de interesses, por um lado, e conflitos de obrigação que são expressos como dilemas éticos e sofrimento moral, do outro lado. Com base nisso, são formuladas recomendações para a formação profissional, a investigação e os comitês de ética hospitalares.

The Ethical Conflicts of“Moral Majority” and Homosexual“ Minority” / 中国医学伦理学

This article looked at the conflicts in depth between the “moral majority” and vulnerable to HIV homosexu-al of “minority”.Both group of the moral and status of social were discussed , and then put forward social justice and in-clusive moral of “moral majority” and“minority”, and take the analysis from the perspective of the “moral majority” and“minority” for the Ethics .

Ética e psicanálise / Ethics and psychoanalysis

O trabalho visa a salientar alguns aspectos que identificam, inicialmente, o entendimento do desenvolvimento ético do indivíduo a partir dos trabalhos de Freud que discutem a lei proibitória do incesto e do parricídio, bem como o lançamento das bases da estrutura social. A partir destes aspectos, discutem-se as questões éticas relativas às atividades do psicanalista, dando uma ênfase especial a questões técnicas relacionadas às conflitivas que podem surgir dentro do setting psicanalítico.

The intention of this paper is to emphasize some aspects which initially identify the un-derstanding of the ethical development of a person, from Freud’s works as a starting point, which discuss the prohibitory law of incest and of parricide, as well as the foun-dations of social structure. From these vantage points, the ethical issues concerning the activities of the psychoanalyst are discussed, with special emphasis on technical aspects related to the conflicts which may arise within the psychoanalytical setting.

El trabajo busca subrayar algunos aspectos que identifican, inicialmente, el entendimiento del desarrollo ético del individuo a partir de los trabajos de Freud que discuten la ley prohibitoria del incesto y del parricidio, bien como el lanzamiento de las bases de la estructura social. A partir de estos aspectos, se discuten los temas éticos relativos a las actividades del psicoanalista, dando especial énfasis a los temas técnicos relacionados a las conflictivas que pueden surgir dentro del setting psicoanalítico.

Ethical Thinking about CTICU / 中国医学伦理学

CTICU is a place in which many patients with critical cardiothoracic and vascular disease are centered. Owning skillful medical underwent complex and dangerous cardiopulmonary operation and the patients underwent complex and dangerous cardiopulmonary operation and the dying can get immediately effective treatment and intensive care as well as good effects. HOwever, We often face some new ethical challenge in which ethical conflicts about use of high-new technology and abandoning treatment or surgery are the most typical while we hae gotten interests in CTICU. This paper is to do somw discussion about the ethical problem and the ethical criterions according to clinical characteristics in CTICU.

The Ethical Questioning of Liver Transplantation / 中国医学伦理学

China has already become a country with large scale liver transplantation in the world in 2004. However, against the background of severe inequity in health care resource allocation, what hides behind the great increase of liver transplantation surgeries is a sharp ethical conflict. Organ transplantation is a high - tech operation, which has not only technical requirements but also ethical requirements. The obtaining of organs must follow ethical principles; the decision about the recipients must follow both medical and social standards; the benefit for the recipient must exceed the loss for the provider; justice must be sought in organ allocation. Therefore, liver transplantations that do not accord with medical indications are against bioethical principles. The zeal for liver transplantation doesnt fit into the situation of our country at all. The source of organs must be controlled according to internationally recognized ethical principles, the ethical training for surgeons must be strengthened, so that the development of liver transplantation in China can be in a healthy track.