Percepción de médicos intensivistas de adultos sobre el aporte de la consultoría ético-clínica / Opinion about clinical ethics consultation among intensivist physicians

Background: Clinical ethics consultation services and their methods vary and they are seldom evaluated. Only one formal system of individual clinical ethics consultation has been reported in Chile, with a ten-year registry. Aim: To evaluate the opinion of intensivist physicians about the contribution of clinical ethics consultation. Material and Methods: An anonymous and voluntary questionnaire consulting their opinion about clinical ethics consultations was sent to 38 intensivist physicians. Results: The questionnaire was answered by 28 professionals. Eighty four percent of respondents considered that ethics consultation contributed to improve patients' quality of care, 92% responded that this practice helps in decisions about limitation of treatments or life support, and 96% expressed that it also was a positive support for patients and their relatives. Seventy two percent of respondents considered that ethics consultations enhanced their ethical sensibility, 76% that they improved their understanding of clinical ethics topics, and 72% declared that it decreased their stress in complex decision-making. Conclusions: Clinical ethics consultation provides a positive support for improvements in clinical decision-making and in the quality of patients' care.

Ethical support to psychiatry residents: a report of a Brazilian ethics consultation group

SUMMARY OBJECTIVE: It is not uncommon for medical residents to deal with critically ill patients who frequently show several ethical and human dilemmas, highlighting the need for a consultation with ethical specialists. The objective of this article is to present a description of a Brazilian Ethics Consultation group designed to attend psychiatry residents. METHODS: This article reports a case of a critically ill patient with Borderline Personality Disorder with multiple intervention failures and several ethical conflicts who was seen by a resident and supported by an ethics consultation group. RESULTS: When medical residents and medical staff face severe and unusual ethical dilemmas, they might feel unprepared and have ones' mental health impaired. Thus, this article reports a successful ethics consultation and discusses its development in other academic institutions. CONCLUSION: Medical educators and staff from academic hospitals should pay attention to the needs of the medical residents. The development and support of ethics consultation groups must be provided to fulfill the need of those residents who face serious ethical and human dilemmas.

Contexto geopolítico, globalización, crisis civilizatoria y paz en Colombia / Geopolitical context, globalization, civilizing crisis, and peace in Colombia

El presente artículo, trata de confrontar los fundamentos e ideas fuerza que caracterizan la globalización como expresión hegemonizada del modelo de desarrollo capitalista en su fase actual, de corte financiero especulativo y con énfasis predominantemente extractivista, con uno de los factores característicos y determinares de la búsqueda y construcción de idearios e imaginarios de paz en Colombia.

This article aims to compare the foundations and ideas, which characterize globalization as a hegemonic expression of the model of the capitalist development,in its current state, of a speculative and financial type and predominantly extractive, with one of the characteristic and determining factors for the search and the construction of ideologies and imaginaries of peace in Colombia.

Falo o Fallopio? Consentimiento informado, anatomías equívocas y Divergencias del Desarrollo Sexual: aspectos médicos, legales y bioéticos / Phallus or Fallopian? Informed consent, equivocal anatomies and Divergences of Sex Development medical, legal and bioethical aspects / Falo ou Fallopio? Consentimento informado, anatomías equívocas e Divergências do Desenvolvimento Sexual: aspectos médicos, legais e bioéticos

Los procesos de toma de decisiones en escenarios de gran impacto sobre el proyecto vital de niños, niñas y adolescentes, como la intervención médica en Divergencias del Desarrollo Sexual (DDS), requieren de intervenciones multidisciplinarias que trascienden el ámbito biológico y legal. Las DDS ofrecen un escenario que desafía los estereotipos binarios de género y plantea otras posibilidades culturales con respecto a la construcción de subjetividades. De una “política de género óptimo”, se ha evolucionado a una “política de consentimiento pleno”, basada en el respeto a la autonomía, la no maleficencia y la promoción del libre desarrollo de la personalidad. Sin embargo, la complejidad de los casos de DDS, exige que las decisiones sean individualizadas en cada situación. En Colombia, la Corte Constitucional ha ofrecido ejemplos significativos de jurisprudencia sobre este tema, si bien no pueden ser tomados como un modelo simplificado para la solución de casos específicos. Desarrollar los debidos procesos para garantizar lo que la Corte ha denominado un “consentimiento libre, cualificado y permanente” es una labor institucional realizada por equipos multidisciplinarios, en los cuales, la articulación entre familia, equipo de salud, comités de bioética y el concurso del paciente, puede contribuir en la calidad de la toma de decisiones.

The decision-making processes in spaces of great impact on the vital project of boys, girls and teenagers, like medical intervention in Divergences of Sex Development (DSD), requires multidisciplinary interventions that transcend the biological and legal scope. The DSD offer a stage that challenge the binary gender stereotypes and propose another cultural possibilities regarding the construction of subjectivities. A “gender policy optimal” has evolved into a “full consent policy” based on respect for autonomy, nonmaleficence and promotion the free development of the personality. However, the complexity of the cases of DSD, requires that decisions be individualized in each situation. In Colombia, the Constitutional Court has provided significant examples of case law on this issue, although they cannot be taken as a simplified model for the solution of specific cases. The Development of proper procedures to ensure what the Court has called a “free, qualified and permanent consent” is an institutional work achieved by multidisciplinary teams, in which the linkages between family, health team, bioethics committees and the contest patient, may contribute to the quality of the decision making.

Os processos de tomada de decisão em situações de alto impacto sobre o projeto vital das crianças e adolescentes, tais como a intervenção médica em diferenças de desenvolvimento sexual (DDS), necessitam de intervenções multidisciplinares que transcendem o biológico e legal. Os DDS oferecem um cenário que desafia os estereótipos binários de gênero e eleva outras possibilidades culturais em relação à construção de subjetividades. De uma “política de gênero” ótimo “evoluiu para uma” política de pleno consentimento “, baseado no respeito à autonomia, a não maleficência e a promoção do livre desenvolvimento da personalidade. No entanto, a complexidade dos processos de DSD, exige que as decisões sejan individualizadas para cada situação. Na Colômbia, a Corte Constitucional tem oferecido exemplos significativos de jurisprudência sobre este assunto, embora não possam serem tomados como um modelo simplificado para a solução de cada caso específico. Desenvolver os devidos processos para garantir que o Tribunal tem chamado de “consentimento livre, permanente e qualificado” é um trabalho institucional feito por equipes multidisciplinares em que as ligações entre a família, equipe de saúde, comitês de bioética e o concurso do paciente, pode contribuir na qualidade de tomada de decisão.

Perfil das consultorias de bioética clínica envolvendo famílias que dificultaram a resolução de problemas / Profile of clinical bioethics consultancies involving families which hindered the resolution of problems

Este estudo avaliou 116 consultorias de bioética clínica nas quais as famílias dos pacientes dificultaram a resolução do problema ou do conflito ético. Foram observados os seguintes aspectos: solicitantes; especialidades; registros nos prontuários eletrônicos; pacientes e relações familiares. A maior parte das consultorias (71 por cento) foi gerada pelas solicitações dos médicos. Os serviços de Medicina Interna, Pediatria e Psiquiatria demandaram 56 por cento das consultorias. Foram encontrados registros de pedidos de consultoria nos prontuários de 79 por cento dos pacientes, dos quais 71 por cento foram respondidos no mesmo dia ou no seguinte. O número de consultorias por sexo do paciente foi semelhante e a idade média, de 28 anos. Em relação à procedência, 54 por cento eram de Porto Alegre. As relações familiares naturalmente impostas (71 por cento) foram mais identificadas. É importante que outros estudos sejam realizados com vistas a permitir um adequado entendimento dos problemas éticos e de suas possíveis resoluções.

This study evaluated 116 records of clinical bioethics consultation in which the patients’ family made difficultthe resolution of the problem or ethical conflict. The following aspects were evaluated: Applicants, MedicalSpecialties, Electronic Health Records, Patients and Family Relationships. Physicians requested 71% of the Bioethics consultation. The Internal Medicine, Pediatrics and Psychiatry Services demanded the majority numberof consultations (56%). The patients who had their consultations registered in electronic medical records were 79%. As for response, 71% of consultations were seen on the same day or the day after requested. Thepercentages of male and female patients were, respectively, 48% and 52% with a mean age of 28 years, 54%of the patients were from Porto Alegre. The naturally imposed family relationships (71%) were the more prevalent. It is very import that other studies be performed in order to generate adequate comprehension aboutethical problems and their possible solutions.

Desenvolvimento da dimensão educacional dos Comitês de Ética em Pesquisa (CEPs) / Desarrollo de la dimensión educacional de los Comités de Ética en Investigación (CEPs) / Development of the educational dimension of ethics of research committees (ERCs)

A importância do caráter educativo e consultivo dos Comitês de Ética em Pesquisa (CEPs) torna relevante pesquisas que busquem investigar essas dimensões dos referidos comitês. Objetivos: analisar como os CEPs têm realizado seu papel educacional e consultivo; averiguar se os pareceristas têm alguma formação sobre ética em pesquisa; identificar se os pesquisadores tiveram orientações sobre ética em pesquisa em sua trajetória acadêmica. Estudo quantitativo e descritivo, aprovado pelo CEP/UESB sob protocolo 134/2009, realizado com 95 informantes e analisado pelo Software Sphinx. De acordo com os dados obtidos, cerca de 71,5 por cento dos participantes da pesquisa consideram as atividades educativas e consultivas realizadas pelo CEP pouco freqüentes ou inexistentes; 60 por cento de pareceristas do CEP têm algum tipo de formação ética e 66,7 por cento dos pesquisadores participantes tiveram alguma abordagem ética na trajetória acadêmica. Estes dados indicam que os CEPs necessitam de maior apoio institucional e investimento para a consolidação de sua dimensão educativo-consultiva.

La importancia del carácter educativo y consultivo de los comités de ética en investigación (CEIs) destaca el valor de estudios que indaguen esas dimensiones en dichos comités. Objetivos: analizar como los CEIs han realizado su papel educacional y consultivo; averiguar si los consultores tienen alguna formación sobre ética en investigación; identificar si los investigadores tuvieron orientaciones sobre ética en investigación en su trayectoria académica. Estudio cuantitativo y descriptivo, aprobado por el CEP/UESB bajo protocolo 134/2009, realizado con 95 informantes y analizado por el Software Sphinx. De acuerdo con los dados obtenidos, cerca de 71,5 por ciento de los participantes de la investigación consideran las actividades educativas y consultivas realizadas por el CEI poco frecuentes o inexistentes; 60 por ciento de los consultores del CEI tienen algún tipo de formación ética y 66,7 por ciento de los investigadores participantes tuvieron alguna aproximación ética en su trayectoria académica. Estos datos indican que los CEIs necesitan mayor apoyo institucional e inversión para la consolidación de su dimensión educativo-consultiva.

The importance of the educational and consulting nature of ethics of research committees (ERCs) highlights the value of research which studies these dimensions in the committees. Aims: to analyze how ERCs have carried out their educational and consulting role; to learn whether advisors have some training in research ethics; to identify whether researchers had guidance about research ethics in their academic career. This is a quantitative and descriptive study approved by CEP/UESB under protocol 134/2009, carried out with 95 informants and analyzed by Software Sphinx. According to data obtained, nearly 71.5 percent research participants consider educational and consulting activities carried out by ERC infrequent or lacking; 60 percent participants have some ethical training in their academic career. These data show that ERCs need greater institutional support and funding in order to consolidate their educational-consulting dimension.

Análisis de una experiencia de consultoría ético clínica en cuidado intensivo / Analysis of a clinical ethics consultation experience in intensive care

Background: Very few patients are presented to ethics committees, and individual ethics consultations are a response to this situation. At the intensive care unit (ICU) in Clínica Alemana, Santiago Chile, an ethics consultation system was organized coordinated with the ethics committee. Aim: To report an evaluation of this ethics consultation system. Material and Methods: Analysis of the frst 50 cases analyzed in the consultation system. Analysis of the responses of intensive care physicians to a questionnaire about the main ethical problems that they face in their work. Results: The consultation system is mainly required by the ICU staff, and reports to the ethics committee. Fifty four percent of patients subjected to consultation were aged over 80 years. The main diagnoses were neurological, oncological or cardiopulmonary problems. The ethical problems identifed were treatment limitation (62 percent), proportionality or futility (42 percent), need of a peaceful death (36 percent), lack of anticipated decisions (28 percent), disagreement between physicians and patient’s family (24 percent), undefined subrogation (14 percent), and abuse of public resources (14 percent). Twenty six of 31 ICU physicians answered the questionnaire, using a 1 (min) to 7 (max.) scale. They found that consultation is helpful for decision making (6.3), useful for improving ethical perception (6.0), supportive for staff (6.5), good for patients (6.3), supportive for families (6.7), and timely performed (5.2). Conclusions: As a complement for the ethics committee’s work, consultation is a valid alternative for ethics counselling and a support for physicians and patient’s families. Its implementation depends on the particularities of each health institution.

Criteria for a good referral system for psychiatric patients: the view from Saudi Arabia

The development and implementation of quality referral systems reflects sound national health planning. This review appraised the data on referral systems, in particular psychiatric referrals, with special reference to Saudi Arabia. A computer search was made of relevant literature in the past 2 decades. The rate and process of referring patients through referral letters varies globally across practice settings and is initiated by an array of factors linked with health consumers, health providers and delivery systems. Referral systems, including consultation-liaison services, are an essential component of any health care organization for offering a complete range of good quality, specialized health services

Consultoria em ética clínica na Suíça / Clinical ethics consultancy in Switzerland

A realização de Consultorias em Ética Clínica tem sido reduzida, muitas vezes, a uma simples aplicação de um método de análise de casos baseados em princípios. A consultoria seria reduzida a uma simples avaliação de um conflito entre princípios. A proposta de uma abordagem baseada em uma Deliberação de Caso Moral pode ser uma alternativa importante, onde o consultor atua como facilitador e não tomando decisões que cabem aos profissionais de saúde.

Clinical Ethics Consultancy, often, has been reduced as a simple method of case analysis based on principles. The consultancy would be reduced to a simple evaluation of a conflict between principles. The proposed approach based on a Moral Case Deliberation could be an important alternative, where the consultant acts as a facilitator and not as a decision maker.

culturally sensitive consultation model

Cultural sensitivity is not only about those patients who come from a different country to that of the practitioner, but also includes those with other differences such as family background, education, religion, belief system or socio-political outlook. If the patient feels their beliefs, values, and practices are understood and respected by the practitioner, there is an increased likelihood a good relationship will be established and the patient will trust the doctor and the clinical procedures. To be more culturally sensitive in consultations, three additional variables ' ethnocentrism, health literacy and transcultural perceptions of illness need to be taken into account. It is near impossible for doctors to undertake education for themselves on the ever-growing variety of cultural factors that can influence the interaction with patients. Some practical ways of communicating are outlined in the use of the 'Cultural Awareness Tool' and Narrative Therapy

Quranic concept of breastfeeding, weaning and consultation

According to AUR'AN breastfeeding is recommended for two years as minimum duration [it is a must]. If weaning is considered agreement of both parents Ipus consulation are essential at weather weaning took place before or after 24 months of breastfeeding. Babies might autowean themselves according to AUR'AN