[The Chilean Health Care System: the task ahead]. / El Sistema de Salud de Chile: una tarea pendiente.

The most important event in Chilean public health in the XXth Century was the creation of the National Health Service (NHS), in 1952. Systematic public policies for the promotion of health, disease prevention, medical care, and rehabilitation were implemented, while a number of more specific programs were introduced, such as those on infant malnutrition, complementary infant feeding, medical control of pregnant women and healthy infants, infant and adult vaccination, and essential sanitation services. In 1981, a parallel private health care system was introduced in the form of medical care financial institutions, which today cover 15% of the population, as contrasted with the public system, which covers about 80%. From 1952 to 2014, public health care policies made possible a remarkable improvement in Chile's health indexes: downward trends in infant mortality rate (from 117.8 to 7.2 x 1,000 live births), maternal mortality (from 276 to 18.5 x 100,000), undernourished children < 5 years old (from 63% to 0.5%); and upward trends in life expectancy at birth (from 50 to 79,8 years), professional hospital care of births (from 35% to 99.8%), access to drinking water (from 52% to 99%), and access to sanitary sewer (from 21% to 98.9%). This went hand in hand with an improvement in economic and social indexes: per capita income at purchasing power parity increased from US$ 3,827 to US$ 20,894 and poverty decreased from 60% to 14.4% of the population. Related indexes such as illiteracy, average schooling, and years of primary school education, were significantly improved as well. Nevertheless, compared with OECD countries, Chile has a relatively low public investment in health (45.7% of total national investment), a deficit in the number of physicians (1.7 x 1,000 inhabitants) and nurses (4.8 x 1,000), in the number of hospital beds (2.1 x 1,000), and in the availability of generic drugs in the market (30%). Chile and the USA are the two OECD countries with the lowest public investment in health. A generalized dissatisfaction with the current Chilean health care model and the need of the vast majority of the population for timely access to acceptable quality medical care are powerful arguments which point to the need for a universal public health care system. The significant increase in public expenditure on health care which such a system would demand requires a sustainable growth of the Chilean economy.

[Keynote address to the 19th congress of ALANAM]. / Discurso de inauguración de la XIX Reunión del Consejo Directivo de ALANAM.

In his keynote address to the international seminar of the ALANAM (Association of Latin American National Academies of Medicine), held October 28-30, 2010, in Santiago, Chile, Dr. Alejandro Goic, President of the Chilean Academy of Medicine, discussed the state of health and of medical and health research in Latin American countries. He called attention to the fact that the National Academies of Medicine are learned and honorific institutions whose main function is to reflect on, and foster, medical practice, medical education, and public health. He noted that medical doctors bear a great individual and collective responsibility in the organization and management of sanitary services, but that health care as such concerns all citizens. Poverty is one of the most important factors conditioning the state of health in any society, particularly in developing countries. Because of the very nature of the medical profession, doctors are acquainted not only with the physical and mental ailments that afflict the poor, but also with their precarious housing, income, and labor conditions, as well as with how difficult it is for them to have access to good health care and education. He emphasized that health care is not only a technical, administrative and economic institution, but a moral one as well. When the economic considerations of the health care industry and its financial mechanisms prevail over the medical needs of the general population, a severe social problem arises to the extent that important segments of the population are denied access to health care, and preventable human suffering is left unattended. Society and governments have the responsibility of financing health services and ensure that the humanitarian ends of medicine are met in health care services and sanitary institutions. The superior aim in health care should always be to afford a humane, caring, and respectful relationship between health care professionals and all users of the health care system without exception.

Dr. Werner Roeschmann von Bischoffshausen / Werner Roeschmann von Bischoffshausen

Con profundo pesar hemos recibido la noticia del fallecimiento del Dr. Werner Roeschmann von Bischoffshausen, ocurrido en Santiago el 22 de abril pasado. El Dr. Roeschmann estuvo ligado estrechamente a la Sociedad Médica de Santiago y, en particular, a la Revista Médica de Chile, su órgano oficial. Nacido en Chillán en 1914, cursó sus estudios en el Colegio Alemán y, luego, en la Facultad de Medicina de la Universidad de Chile, obteniendo el título de Médico-Cirujado en 1940. Su tesis de título versó sobre "Estudio del urobilinógeno fecal en las enfermedades hepatobiliares. El Internado lo realizó en la Cátedra de Medicina del Profesor Dr. Hernán Alessandri Rodríguez, en el Hospital del Salvador de Santiago. Una vez graduado, se incorporó al Servicio de Medicina del mismo hospital, donde se desempeñó hasta su jubilación como médico internista y gastroenterólogo y ayudante de la cátedra universitaria. Además, ejerció activamente la medicina privada. Integrante del grupo de Hepatología, tuvo bajo su responsabilidad durante muchos años el tratamiento anticoagulante de los pacientes de todo el hospital, en una época en que se introducía tímida y cautelosamente este tipo de terapia en nuestro país

Dr. Werner Roeschmann von Bischoffshausen / Werner Roeschmann von Bischoffshausen

Con profundo pesar hemos recibido la noticia del fallecimiento del Dr. Werner Roeschmann von Bischoffshausen, ocurrido en Santiago el 22 de abril pasado. El Dr. Roeschmann estuvo ligado estrechamente a la Sociedad Médica de Santiago y, en particular, a la Revista Médica de Chile, su órgano oficial. Nacido en Chillán en 1914, cursó sus estudios en el Colegio Alemán y, luego, en la Facultad de Medicina de la Universidad de Chile, obteniendo el título de Médico-Cirujado en 1940. Su tesis de título versó sobre "Estudio del urobilinógeno fecal en las enfermedades hepatobiliares. El Internado lo realizó en la Cátedra de Medicina del Profesor Dr. Hernán Alessandri Rodríguez, en el Hospital del Salvador de Santiago. Una vez graduado, se incorporó al Servicio de Medicina del mismo hospital, donde se desempeñó hasta su jubilación como médico internista y gastroenterólogo y ayudante de la cátedra universitaria. Además, ejerció activamente la medicina privada. Integrante del grupo de Hepatología, tuvo bajo su responsabilidad durante muchos años el tratamiento anticoagulante de los pacientes de todo el hospital, en una época en que se introducía tímida y cautelosamente este tipo de terapia en nuestro país

Semblanza del Profesor Dr. Hernán Alessandri R / Biographical notes on Professor Hernan Alessandri, MD

Hernán Alessandri, a renowned Chilean medical educator, was born in Santiago in 1900. He received his medical degree at the University of Chile in 1923. When in 1927 his father, then President of Chile, was sent into exile, he used the opportunity to deepen his medical knowledge in France and Germany. At the University of Chile, he became successively Professor of Clinical Medicine (1932), of Medical Semiology (1937), and Full Professor and Chair of Medicine (1944). At the Hospital del Salvador in Santiago, he organized a Clinical Department exemplary for its discipline, academic environment and dedication to patients and students. He was one of the prime movers for the reform of medical teaching in 1943, created medical residency programs for the training of specialists in 1952, served as Dean of the Faculty of Medicine from 1958 to 1962, and was a founding member of the Chilean Academy of Medicine (1964). He was the first Latin American to be named Honorary Member of the American College of Physicians (1968) and became Emeritus Professor of the University of Chile in 1973. He died in his hometown in 1982. His disciples and friends established in his honor a social and teaching foundation which they named after him. His clinical and diagnostic skills, along with his outstanding intelligence, made him the most brilliant clinician of his time and an exceptional medical educator who has inspired several generations of physicians. (AU)

[Notes on euthanasia]. / Apuntes sobre la eutanasi.

In the Judeo-Christian tradition, human life is held to be sacred, a semblance of the divine and a gift from God which the individual cannot dispose of at his or her own will. Hence, these monotheistic religions have made of the crime of murder a transgression of God's own commandment not to kill and have extended the applicability of this commandment to the practice of euthanasia and suicide. On the other hand, some non-religious traditions offer plausible reasons favoring euthanasia. This is a delicate matter for physicians, since the Hippocratic tradition forbids euthanasia and because as care-givers they must also bear the psychological, moral and emotional burden of carrying it out. Physicians are trained to preserve life but not to bring it to an end. As human beings, they must always respect the principle of nonmaleficence, and as physicians they must always respect as well the principle of beneficence. It is difficult to accept the fact that ending a human life can be an act of beneficence. In order to differentiate between passive and active euthanasia, the concept of proportionality of medical acts must be brought into consideration. For instance, using high doses of opiates to alleviate pain or withholding the use of an extraordinary method of treatment are not passive acts aimed at ending the life of a terminally ill patient, but medical acts that are reasonable, judicious and proportionate to the condition and irreversibility of a patient's illness. Therefore, so-called passive euthanasia cannot be considered the same as euthanasia. On the other hand, medically assisted suicide is a deceitful form of active euthanasia. The aim of this act is to cause death and the physician is morally responsible for such a death, since he is providing the means for bringing a human life to an end. Many times the desire to die expressed by terminally ill elderly and helpless patients is a request for help and an expression of reproach against a society that allows for their abandonment and neglect.

[Biographical notes on Professor Hernan Alessandri, M.D]. / Semblanza del Profesor Dr. Hernán Alessandri R.

Hernán Alessandri, a renowned Chilean medical educator, was born in Santiago in 1900. He received his medical degree at the University of Chile in 1923. When in 1927 his father, then President of Chile, was sent into exile, he used the opportunity to deepen his medical knowledge in France and Germany. At the University of Chile, he became successively Professor of Clinical Medicine (1932), of Medical Semiology (1937), and Full Professor and Chair of Medicine (1944). At the Hospital del Salvador in Santiago, he organized a Clinical Department exemplary for its discipline, academic environment and dedication to patients and students. He was one of the prime movers for the reform of medical teaching in 1943, created medical residency programs for the training of specialists in 1952, served as Dean of the Faculty of Medicine from 1958 to 1962, and was a founding member of the Chilean Academy of Medicine (1964). He was the first Latin American to be named Honorary Member of the American College of Physicians (1968) and became Emeritus Professor of the University of Chile in 1973. He died in his hometown in 1982. His disciples and friends established in his honor a social and teaching foundation which they named after him. His clinical and diagnostic skills, along with his outstanding intelligence, made him the most brilliant clinician of his time and an exceptional medical educator who has inspired several generations of physicians.

[The diagnosis of death]. / Diagnóstico de muerte.

This paper undertakes an analysis of the scientific criteria used in the diagnosis of death and underscores the importance of intellectual rigor in the definition of medical concepts, particularly regarding such a critical issue as the diagnosis of death. Under the cardiorespiratory criterion, death is defined as "the irreversible cessation of the functioning of an organism as a whole", and the tests used to confirm this criterion (negative life-signs) are sensitive and specific. In this case, cadaverous phenomena appear immediately following the diagnosis of death. On the other hand, doubts have arisen concerning the theoretical and the inner consistency of the criterion of brain death, since it does not satisfy the definition of "the irreversible cessation of the functioning of an organism as a whole", nor the requirement of "total and irreversible cessation of all functions of the entire brain, including the brain stem". There is evidence to the effect that the tests used to confirm this criterion are not specific enough. It is clear that brain death marks the beginning of a process that eventually ends in death, though death does not occur at that moment. From an ethical point of view, the conflict arises between the need to provide an unequivocal diagnosis of death and the possibility of saving a life through organ transplantation. The sensitive issue of brain death calls for a more thorough and in-depth discussion among physicians and the community at large.

[The ethics of health care organization]. / Etica de la organización de la atención de salud.

Health care organization is not only a technical issue. Ethics gives meaning to the medical profession's declared intent of preserving the health and life of the people while honoring their intelligence, dignity and intimacy. It also induces physicians to apply their knowledge, intellect and skills for the benefit of the patient. In a health care system, it is important that people have insurance coverage for health contingencies and that the quality of the services provided be satisfactory. People tend to judge the medical profession according to the experience they have in their personal encounter with physicians, health care workers, hospitals and clinics. Society and its political leaders must decide upon the particular model that will ensure the right of citizens to a satisfactory health care. Any health care organization not founded on humanitarian and ethical values is doomed tofailure. The strict adherence of physicians to Hippocratic values and to the norms of good clinical practice as well as to an altruistic cooperative attitude will improve the efficiency of the health care sector and reduce its costs. It is incumbent upon society to generate the conditions where by the ethical roots of medical care can be brought to bear upon the workings of the health care system. Every country must strive to provide not only technically efficient medical services, but also the social mechanisms that make possible a humanitarian interaction between professionals and patients where kindness and respect prevail.