ABSTRACT
PURPOSE OF REVIEW: Palliative sedation is a standard procedure used in palliative care especially for patients at the very end of their lives, who are enduring otherwise intractable suffering. It consists of the administration of sedatives and, when necessary, other drugs, usually by infusion, either subcutaneously or intravenously, at the necessary rate to achieve the patient's relief, by means of reducing the consciousness of the patient. If this administration is not discontinued, the usual outcome is the patient's death. So, the most frequent criticisms regarding the procedure are those that consider it as a form of euthanasia. The intention of the review is analyzing the status questionis in Europe and Latin America. RECENT FINDINGS: Current thinking and research about this issue refers especially to the terminology, the boundaries between palliative sedation and slow euthanasia, especially in pediatric settings, the lacking of precise definition for concepts such as refractory symptoms and unbearable suffering, and the place for existential suffering in this context; the ethical positioning of Latin-American normative and authors is similar to that of Europe. SUMMARY: It does not seem that solution to the conflicting points will come from better guidelines or more experts' meetings. Instead, efforts should be directed to reinforce moral, professional integrity, within the framework of an ethics of virtue, as inherent to palliative care. Such ethics can effectively be taught and infused, and then required to all healthcare professionals.
Subject(s)
Conscious Sedation/methods , Ethics, Medical , Neoplasms/psychology , Palliative Care/methods , Quality of Life/psychology , Stress, Psychological/psychology , Consciousness , Europe , Euthanasia, Passive/ethics , Humans , Hypnotics and Sedatives/administration & dosage , Latin America , Palliative Care/ethicsABSTRACT
Este artículo hace una sucinta revisión de los aspectos éticos de la prescripción a nivel "micro", el de la relación terapéutica, con fundamento en la "teoría de los principios" (de Georgetown), y en los aspectos técnicos de la correcta prescripción según la lex artis, sustentada en la denominada "medicina basada en la evidencia" y en las recomendaciones y publicaciones de la OMS. Luego, se aborda el tema de la prescripción médica en tanto problema de salud pública. Se comenta su impacto social y las presiones indebidas que sufren los médicos para prescribir, especialmente por parte de la industria farmacéutica. Se provee a continuación un marco jurídico, centrado en el llamado Derecho Internacional de los Derechos Humanos. Se considera que podría lograrse el acceso universal a los medicamentos, entendidos como bien social, de fundamental importancia para efectivizar el Derecho a la Asistencia Sanitaria. Se revisan las distintas justificaciones éticas que sostienen este derecho, especialmente la teoría de la justicia de John Rawls.
This paper pretends to draw a brief review upon the ethical aspects of a prescription at a "micro" level, that is of the therapeutic relationship based on the Georgetown "theory of principles" and on the technical aspects of a correct prescription according to the lex artis, sustained on the so-called "evidence based medicine" and on the WHO's requests and publications. It then turns to the subject of the medical prescription as a problem of Public Health. It stops at its social impact and at the undue pressures that doctors must suffer in order to prescribe, especially those coming from the pharmaceutical industry. It also offers a juridical framework focused on the Human Rights' International Law. Universal access to medication should be reached -understood as a social good of fundamental importance- in order to attain the Right to Sanitary Assistance. Several ethical justifications that hold up this right are taken into account, especially Rawls' theory of justice.
Este texto se inicia como uma breve revisão dos aspectos éticos da prescrição em nível "micro", ou seja, a da relação terapêutica, com fundamento na "teoria dos princípios (Georgetown)", e dos aspectos técnicos da correta prescrição segundo a lex artis, sustentada na denominada "medicina baseada em evidência", as recomendações e publicações da OMS. A seguir se aborda o tema da prescrição médica, enquanto problema de saúde pública. Comenta seu impacto social e as pressões indevidas que sofrem os médicos para prescrever, especialmente da indústria farmacêutica. Continuando, apresenta um marco jurídico, centrado no chamado Direito Internacional dos Direitos Humanos. Considera-se que se poderia conseguir o acesso universal aos medicamentos, entendidos como um bem social, de fundamental importância para efetivar o Direito à Assistência Sanitária. Revisam-se as diferentes justificações éticas que sustentam este direito, especialmente a teoria da justiça de Rawls.
Subject(s)
Bioethics , Drug Industry , Drug Prescriptions , Public Health , Argentina , PovertyABSTRACT
Se realiza un análisis detallado de las modificaciones a la Declaración de Helsinki introducidas por la 52 Asamblea General de la Asociación Médica Mundial en octubre del año 2000 en Edimburgo. Luego de una introducción, se efect£a una aproximación general a las reformas de forma y de fondo, seguida por un análisis puntual de cada articulo sustancialmente modificado, comparando además, donde pareció pertinente, las versiones española e inglesa. Ese desarrollo se hace por la v¡a de Comentarios (XXV en total) al texto transcripto de la versión espa¤ola circulante en Internet en el sitio www.wma.net/s/helsinki.html, el 28/11/00. Las frases o párrafos sujetos a análisis se se¤alan recurriendo a diferente tipografia, para fragmentos modificados, nuevos, y texto en inglés. Se analizan los aspectos bioéticos, incluyendo la lectura en ôclave de Derechos Humanos, y los aspectos cientificos de la investigación sobre seres humanos, considerando la actual perspectiva de la Medicina basada en la Evidencia. Conclusiones: 1) todas las modificaciones efectuadas en esta reforma de la Declaración apuntan a reforzar la vigencia efectiva de los Derechos Humanos de los sujetos participantes. 2) seria deseable una ulterior revisi¢n del lenguaje de la versión española, que en muchos puntos es ambigua o poco precisa, e inferior en este aspecto a la versión inglesa.
Subject(s)
Humans , Male , Female , Ethics, Research , Human Experimentation/ethics , Helsinki DeclarationSubject(s)
Bioethics , Ethics, Medical , Argentina , Curriculum , Education, Graduate , Medicine/trendsSubject(s)
Bioethics , Ethics, Medical , Curriculum , Medicine/trends , Education, Graduate , ArgentinaABSTRACT
Most developments supporting the study of bioethics in Argentina are of relatively recent vintage. This article is dedicated to describing those developments- including creation of Argentina's Institute of Medical Humanities, formation of a bioethics working group at the National University of Mar de Plata, initiation of a two-year graduate bioethics course at the same university, and the holding of an international symposium and workshop on bioethics at Mar del Plata in 1988. Particular attention is devoted to the graduate course, the detailed design of which is outlined in Annex 1
Available in Spanish in Bol. Oficina Sanit. Panam 108(5/6):500-11, 1990
Subject(s)
Bioethics , Ethics, Medical , Medicine , Education, Graduate , Curriculum , ArgentinaABSTRACT
Most developments supporting the study of bioethics in Argentina are of relatively recent vintage. This article is dedicated to describing those developments- including creation of Argentina's Institute of Medical Humanities, formation of a bioethics working group at the National University of Mar de Plata, initiation of a two-year graduate bioethics course at the same university, and the holding of an international symposium and workshop on bioethics at Mar del Plata in 1988. Particular attention is devoted to the graduate course, the detailed design of which is outlined in Annex 1
Subject(s)
Bioethics , Ethics, Medical , Medicine/trends , Education, Graduate , Curriculum , ArgentinaABSTRACT
Publicado también como Publicación Científica No. 527
