Breve discurso sobre ética, moral, estética e bioética das relações / Brief speech on ethics, moral aesthetics and bioethics relationship / Breve charla sobre ética, moral, estética y bioética de las relaciones / Bref discours à propos de l'éthique, de la morale, de l'esthétique et de la bioéthique des relations

A proposta deste trabalho é rever os conceitos de ética, moral e estética, e articulá-los com os princípios da bioética das relações, que carregam intrinsecamente princípios psicanalíticos. O ser humano constrói seus valores morais no processo de socialização. A estética como qualidade do sentir, proposta por Freud, não passa pela razão. O senso estético é o que nos possibilitará interpretar o mundo externo e os valores morais ou da cultura. Enquanto "a moral vem de fora, a ética parte de dentro". Assim, diferenciamos os conceitos respectivamente como funções do superego e do ego. A forma ética de lidar com os conflitos das relações humanas dar-se-á com um acordo entre a autonomia individual e a responsabilidade social. A máxima da bioética das relações é a "autonomia responsável". O pensamento ético é a conciliação entre os valores morais internalizados e os sentimentos gerados pela percepção do indivíduo sobre a realidade frente às relações humanas. Assim, diante dos conceitos expostos, concluímos que a ética é a estética da moral.

This paper aims at reviewing the concepts of ethics, moral and aesthetics and articulating them with the principles of bioethics relationship which inherently carry psychoanalytic principles. Human beings build moral values within socialization process. Aesthetics as a feeling quality, proposed by Freud, does not go through reason. Aesthetic senses are what enables reading the external world and moral or cultural values. While "moral comes from outside, ethics comes from the inside", thus it is possible to differentiate the concepts, respectively, as functions of superego and ego. An ethical way of dealing with conflicts of human relationships will happen with an agreement between individual autonomy and social responsibility. The maxim of bioethics relationship is "responsible autonomy". The ethical thought is the conciliation between internalized moral values and the feelings generated by the individual perception about reality within human relationships. Thereby, it is possible to state that ethics is the moral aesthetics.

El propósito de este trabajo es revisar los conceptos de ética, moral y estética y articularlos con los principios de la bioética de las relaciones, que son portadores inherentes de principios psicoanalíticos. El ser humano construye sus valores morales en el proceso de socialización. La estética como cualidad del sentimiento, propuesta por Freud, no pasa por la razón. El sentido estético es el que nos permitirá interpretar al mundo exterior y sus valores morales o culturales. Mientras que "la moralidad viene de afuera, la ética viene de adentro"; así diferenciamos los conceptos respectivamente como funciones del superyó y del yo. La forma ética de abordar los conflictos en las relaciones humanas ocurrirá con la alianza entre la autonomía individual y la responsabilidad social. La moral propuesta por la bioética de las relaciones es la de una "autonomía responsable". El pensamiento ético se dará por la conciliación entre los valores morales internalizados y los sentimientos que genera la percepción de la realidad en las relaciones humanas. Así, a la vista de los conceptos expuestos, concluimos que la ética es la estética de la moral.

Ce travail a pour but de revoir les concepts d'éthique, de morale et d'esthétique et de les articuler aux principes de la bioéthique des relations, qui portent intrinsèquement des principes psychanalytiques. L'être humain construit ses valeurs morales dans le processus de la socialisation. L'esthétique comme qualité du sentir, proposée par Freud, ne passe pas par la raison. Le sens esthétique, c'est ce qui nous permettra d'interpréter le monde extérieur et les valeurs morales ou issues de la culture. Alors que « la morale vient de l'extérieur, l'éthique vient de l'intérieur ¼ ; ainsi, nous différencions ces concepts respectivement en tant que fonctions du super ego et de l'ego. La manière éthique de traiter les conflits des relations humaines sera convenue entre l'autonomie individuelle et la responsabilité sociale. La maxime de la Bioéthique des Relations est « l'autonomie responsable ¼. La pensée éthique est la conciliation entre les valeurs morales intériorisées et les sentiments générés au moyen de la perception, par l'individu, de la réalité face aux relations humaines. Ainsi, étant donné les concepts exposés, nous concluons que l'éthique est l'esthétique de la morale.

A bioethical framework to guide the decision-making process in the care of seriously ill patients.

BACKGROUND: One of the biggest challenges of practicing medicine in the age of informational technology is how to conciliate the overwhelming amount of medical-scientific information with the multiple patients' values of modern pluralistic societies. To organize and optimize the the Decision-Making Process (DMP) of seriously ill patient care, we present a framework to be used by Healthcare Providers. The objective is to align Bioethics, Evidence-based Practice and Person-centered Care. MAIN BODY: The framework divides the DMP into four steps, each with a different but complementary focus, goal and ethical principle. Step 1 focuses exclusively on the disease, having accuracy is its ethical principle. It aims at an accurate and probabilistic estimation of prognosis, absolute risk reduction, relative risk reduction and treatments' burdens. Step 2 focuses on the person, using empathic communication to learn about patient values and what suffering means for the patient. Emphasis is given to learning and active listening, not taking action. Thus, instead beneficence, we trust comprehension and understanding with the suffering of others and respect for others as autonomous moral agents as the ethical principles of Step 2. Step 3 focuses on the healthcare team, having the ethics of situational awareness guiding this step. The goal is, through effective teamwork, to contextualize and link rates and probabilities related to the disease to the learned patient's values, presenting a summary of which treatments the team considers as acceptable, recommended, potentially inappropriate and futile. Finally, Step 4 focuses on provider-patient relationship, seeking shared Goals of Care (GOC), for the best and worst scenario. Through an ethics of deliberation, it aims for a consensus that could ensure that the patient's values will be respected as well as a scientifically acceptable medical practice will be provided. In summary: accuracy, comprehension, understanding, situational awareness and deliberation would be the ethical principles guiding each step. CONCLUSION: Hopefully, by highlighting and naming the different perspectives of knowledge needed in clinical practice, this framework will be valuable as a practical and educational tool, guiding modern medical professionals through the many challenges of providing high quality person-centered care that is both ethical and evidence based.

Development of an algorithm to aid triage decisions for intensive care unit admission: a clinical vignette and retrospective cohort study.

BACKGROUND: Intensive care unit (ICU) admission triage is performed routinely and is often based solely on clinical judgment, which could mask biases. A computerized algorithm to aid ICU triage decisions was developed to classify patients into the Society of Critical Care Medicine's prioritization system. In this study, we sought to evaluate the reliability and validity of this algorithm. METHODS: Nine senior physicians evaluated forty clinical vignettes based on real patients. The reference standard was defined as the priorities ascribed by two investigators with full access to patients' records. Agreement of algorithm-based priorities with the reference standard and with intuitive priorities provided by the physicians were evaluated. Correlations between algorithm prioritization and physicians' judgment of the appropriateness of ICU admissions in scarcity and nonscarcity settings were also evaluated. Validity was further assessed by retrospectively applying this algorithm to 603 patients with requests for ICU admission for association with clinical outcomes. RESULTS: Agreement between algorithm-based priorities and the reference standard was substantial, with a median κ of 0.72 (interquartile range [IQR] 0.52-0.77). Algorithm-based priorities demonstrated higher interrater reliability (overall κ 0.61, 95% confidence interval [CI] 0.57-0.65; median percentage agreement 0.64, IQR 0.59-0.70) than physicians' intuitive prioritization (overall κ 0.51, 95% CI 0.47-0.55; median percentage agreement 0.49, IQR 0.44-0.56) (p = 0.001). Algorithm-based priorities were also associated with physicians' judgment of appropriateness of ICU admission (priorities 1, 2, 3, and 4 vignettes would be admitted to the last ICU bed in 83.7%, 61.2%, 45.2%, and 16.8% of the scenarios, respectively; p < 0.001) and with actual ICU admission, palliative care consultation, and hospital mortality in the retrospective cohort. CONCLUSIONS: This ICU admission triage algorithm demonstrated good reliability and validity. However, more studies are needed to evaluate a difference in benefit of ICU admission justifying the admission of one priority stratum over the others.

Festa de família: a função da mãe em uma família incestuosa / The Celebration: the role of the mother in an incestuous family / La celebración: la función de la madre en una familia incestuosa

O filme Festa de família (Festen), escrito e dirigido por Thomas Vinterberg, tem seu roteiro sob a ideologia dos mandamentos do Dogma 95, do qual é coautor. Essas regras propõem outro modo de fazer uso do cinema, menos comercial. A trama do filme se baseia nos conflitos familiares, apresentada através da história da numerosa família Klingenfeldt, que se reúne em um hotel que havia pertencido à família, para celebrar o aniversário do patriarca, que comemora 60 anos e é admirado e respeitado por todos. Mas essa aparente amabilidade será questionada durante a celebração quando Christian faz um discurso revelando o segredo da família. Vamos analisar o funcionamento dessa família desde o vértice psicanalítico, observando a relação incestuosa. O herói do filme, Christian, vai questionar a figura paterna em uma aparente sagrada família, desconstruindo a ideia do pai bom, apresentando-o como um padre padrone. Porém o que não fica tão evidente é que, após Christian sobrepujar o pai e retirar-se da festa, a mãe abandona seu marido, indo ao encontro do filho. O propósito dessas observações sobre configurações psíquicas familiares foi o de lançar luz sobre a dinâmica do vínculo relacional da mãe na família incestuosa. Esse mesmo comportamento pode ser observado na tragédia escrita por Sófocles, quando Jocasta, viúva de Laio, que foi morto por Édipo, se casa com Édipo; em Festa de família observamos esse comportamento quando Else abandona Helge e vai ao encontro de Christian...

The film Festen, written and directed by Thomas Vinterberg, has ideological principles that are the rules of Dogma 95, of which he is coauthor. These rules propose another way to make use of the cinema language, transforming the relationship between the factual reality with the camera, which is already saturated by the most common commercial cinema. The film's plot takes place showing family conflict, counting - is an episode of the history of the family Klingenfeldt when it meets in a hotel to celebrate the birthday of the Patriarch of a holy family, who is 60 years old, which seems, all want it and respect it deeply. This apparent harmony will be questioned during the birthday celebration reached climax at the moment which becomes public a family secret, showing - is starting from that moment the consequences of this revelation. This paper analyzes, from the psychoanalytic vertex, the role of the mother in this family observing its operation and its aftermath in this incestuous family. The hero of the film, Christian, who is the eldest son, misfortune of the good father image and shows the contribution of his mother in preserving the status quo. This is one of the purposes of the Dogma, ending the image of sacred family film has. We should also note the fact that Christian after deliver - is his padre padrone, mother leaves her husband and goes with his son. The purpose of these observations about the psychic family configurations is to shed light on the dynamics of relational loop of the mother in the incestuous family. In mythology, this incestuous behavior can be seen in Oedipus when Jocasta, widow of Layo marries Oedipus, in Festen, Else desist from Helge and follows Christian...

El guion de la película Festen, escrita y dirigida por Thomas Vinterberg, tiene como principio ideológico los mandamientos del Dogma 95, del cual Vinterberg es coautor. Estas reglas proponen un uso menos comercial del cine. La trama de la película tiene como base los conflictos familiares presentados a través de la historia de los Klingenfeldt, una numerosa familia, que en esta ocasión se encuentra reunida en el hotel familiar para celebrar el sexagésimo cumpleaños del patriarca, un hombre querido y admirado por todos. Esta aparente armonía es cuestionada durante la celebración del cumpleaños cuando Christian, el hijo mayor, torna público un secreto de familia, mostrándose a partir de ese momento las consecuencias de esta revelación. En este trabajo se analiza el funcionamiento de esa familia, que es una familia incestuosa, desde el vértice psicoanalítico. El héroe de la película, Christian, cuestiona la figura paterna de una aparente sagrada familia, desconstruyendo la imagen del buen padre, presentándolo como un padre padrone. Lo que no queda tan evidente es que después que Christian logra libertarse de su padre y retirarse de la fiesta, es seguido por su madre quien abandona a su esposo y va al encuentro del hijo. El propósito de estas observaciones sobre las configuraciones psíquicas familiares es arrojar luz sobre la dinámica del vínculo relacional de la madre en la familia incestuosa. En la mitología, este comportamiento incestuoso puede ser observado en Edipo cuando Yocasta, viuda de Layo se casa con Edipo; en Festen, Else abandona a Helge y lo busca a Christian...

Festa de família: a função da mãe em uma família incestuosa / The Celebration: the role of the mother in an incestuous family / La celebración: la función de la madre en una familia incestuosa

O filme Festa de família (Festen), escrito e dirigido por Thomas Vinterberg, tem seu roteiro sob a ideologia dos mandamentos do Dogma 95, do qual é coautor. Essas regras propõem outro modo de fazer uso do cinema, menos comercial. A trama do filme se baseia nos conflitos familiares, apresentada através da história da numerosa família Klingenfeldt, que se reúne em um hotel que havia pertencido à família, para celebrar o aniversário do patriarca, que comemora 60 anos e é admirado e respeitado por todos. Mas essa aparente amabilidade será questionada durante a celebração quando Christian faz um discurso revelando o segredo da família. Vamos analisar o funcionamento dessa família desde o vértice psicanalítico, observando a relação incestuosa. O herói do filme, Christian, vai questionar a figura paterna em uma aparente sagrada família, desconstruindo a ideia do pai bom, apresentando-o como um padre padrone. Porém o que não fica tão evidente é que, após Christian sobrepujar o pai e retirar-se da festa, a mãe abandona seu marido, indo ao encontro do filho. O propósito dessas observações sobre configurações psíquicas familiares foi o de lançar luz sobre a dinâmica do vínculo relacional da mãe na família incestuosa. Esse mesmo comportamento pode ser observado na tragédia escrita por Sófocles, quando Jocasta, viúva de Laio, que foi morto por Édipo, se casa com Édipo; em Festa de família observamos esse comportamento quando Else abandona Helge e vai ao encontro de Christian.(AU)

The film Festen, written and directed by Thomas Vinterberg, has ideological principles that are the rules of Dogma 95, of which he is coauthor. These rules propose another way to make use of the cinema language, transforming the relationship between the factual reality with the camera, which is already saturated by the most common commercial cinema. The film's plot takes place showing family conflict, counting - is an episode of the history of the family Klingenfeldt when it meets in a hotel to celebrate the birthday of the Patriarch of a holy family, who is 60 years old, which seems, all want it and respect it deeply. This apparent harmony will be questioned during the birthday celebration reached climax at the moment which becomes public a family secret, showing - is starting from that moment the consequences of this revelation. This paper analyzes, from the psychoanalytic vertex, the role of the mother in this family observing its operation and its aftermath in this incestuous family. The hero of the film, Christian, who is the eldest son, misfortune of the good father image and shows the contribution of his mother in preserving the status quo. This is one of the purposes of the Dogma, ending the image of sacred family film has. We should also note the fact that Christian after deliver - is his padre padrone, mother leaves her husband and goes with his son. The purpose of these observations about the psychic family configurations is to shed light on the dynamics of relational loop of the mother in the incestuous family. In mythology, this incestuous behavior can be seen in Oedipus when Jocasta, widow of Layo marries Oedipus, in Festen, Else desist from Helge and follows Christian.(AU)

El guion de la película Festen, escrita y dirigida por Thomas Vinterberg, tiene como principio ideológico los mandamientos del Dogma 95, del cual Vinterberg es coautor. Estas reglas proponen un uso menos comercial del cine. La trama de la película tiene como base los conflictos familiares presentados a través de la historia de los Klingenfeldt, una numerosa familia, que en esta ocasión se encuentra reunida en el hotel familiar para celebrar el sexagésimo cumpleaños del patriarca, un hombre querido y admirado por todos. Esta aparente armonía es cuestionada durante la celebración del cumpleaños cuando Christian, el hijo mayor, torna público un secreto de familia, mostrándose a partir de ese momento las consecuencias de esta revelación. En este trabajo se analiza el funcionamiento de esa familia, que es una familia incestuosa, desde el vértice psicoanalítico. El héroe de la película, Christian, cuestiona la figura paterna de una aparente sagrada familia, desconstruyendo la imagen del buen padre, presentándolo como un padre padrone. Lo que no queda tan evidente es que después que Christian logra libertarse de su padre y retirarse de la fiesta, es seguido por su madre quien abandona a su esposo y va al encuentro del hijo. El propósito de estas observaciones sobre las configuraciones psíquicas familiares es arrojar luz sobre la dinámica del vínculo relacional de la madre en la familia incestuosa. En la mitología, este comportamiento incestuoso puede ser observado en Edipo cuando Yocasta, viuda de Layo se casa con Edipo; en Festen, Else abandona a Helge y lo busca a Christian.(AU)

Análise da dignidade penal e carência de tutela penal nas pesquisas envolvendo seres humanos / Analysis of criminal dignity and the lack of criminal protection in relation to research involving human beings

A evolução da humanidade estimula o desenvolvimento das tecnologias, notadamente no que tange às pesquisas envolvendo seres humanos. Nesse âmbito reside a proteção das pessoas ante os riscos das pesquisas. Este artigo analisa a dignidade penal e carência de tutela penal nas pesquisas envolvendo seres humanos. Nele é constatada a existência de situações graves que demonstram a necessidade desta tutela e a carência de instrumentos aptos a garantir a imperatividade de documentos que regulam a matéria. O artigo afirma que o Direito Penal é o meio estatal mais eficaz para a tutela da vida e integridade física. Salienta que a existência de termo de consentimento para a realização dessas pesquisas é necessária, mas não afasta, contudo, a responsabilidade penal eventualmente existente.

The evolution of humanity encourages the development of technologies, especially in regard to researchinvolving human beings. In this context lies the protection of people from the risks of research. The articleanalyzes the criminal dignity and the lack of criminal protection in relation to research involving human beings. It notes serious situations that demonstrate the need for this protection and the lack of instruments thatguarantee the imperativeness of documents about this subject. It states that Criminal Law is the most effective way to protect life and physical integrity. The article says the consent form is necessary, but it doesn’t avoidthe criminal responsibility.

Concepções sobre o princípio da não maleficência e suas relações com a prudência / Concepciones sobre el principio de la no maleficencia y sus relaciones con la prudencia / Conceptions of the non-maleficence principle and its relationship with the prudence

A origem conceitual da não maleficência, um dos princípios da bioética principialista, pode estar relacionada à prudência, desde a Antiguidade até o período contemporâneo. Por meio da revisão da literatura sobre a ética, foram estudadas as origens e abrangência do conceito de não maleficência. Foi também analisada sua relação com os outros três princípios - autonomia, justiça e beneficência - e os possíveis conflitos entre os mesmos que pudessem exigir, em determinada situação, a hierarquização ou primazia de um sobre outro. No texto, fica evidente que autores contemporâneos consideram o princípio da maleficência como o fundamento de, antes de tudo, não prejudicar e outorgam sua primazia por ser princípio que expressa o bem público, podendo estar acima da autonomia das pessoas.

El origen conceptual de la no maleficencia, uno de los principios de la bioética principialista, puede estar relacionado con la prudencia, desde la antigüedad hasta la época contemporánea. A través de la revisión de la literatura sobre la ética, fueron estudiadas las orígenes y la abarcadura del concepto de no maleficencia. También se analizó su relación con los demás tres principios - autonomía, justicia y beneficencia - y los posibles conflictos entre ellos que podrían requerir, en cualquier situación dada, la jerarquización o la primacía de uno sobre otro. En el texto, queda claro que los autores contemporáneos consideran el principio de la no maleficencia como el fundamento de, antes que nada, no perjudicar y otorgan su primacía por ser el principio que exprime el bien público, pudiendo estar por encima de la autonomía de las personas.

The conceptual origin of non-maleficence, one of the bioethics' principles of principialism may be related to prudence, from ancient times to the contemporary period. Through the review of the literature on ethics, we studied the origins and scope of the non-maleficence concept. Was also analyzed its relationship with the other three principles - autonomy, beneficence and justice - and the possible conflicts between them that might require in any given situation, the ranking or priority of one over another. In the text, it is clear that contemporary authors consider the principle of non-maleficence as the foundation of, firstly, not undermining its primacy because it is the principle that expresses public good, and it may be above the autonomy of individuals.

A doação compulsória de órgãos e os prisioneiros condenados à morte: uma análise sob o ponto de vista da bioética / La donación compulsoria de ó rganos de presos condenados a muerte: un análisis desde la perspectiva de la bioética / The compulsory donation of organs and the death row inmates: an analysis from bioethics standpoint

O artigo visa debater a doação compulsória de órgãos de prisioneiros condenados à morte frente à demanda de órgãos e tecidos que ultrapassa em muito a oferta e leva à necessidade de encontrar medidas para aumentar o número de doações. Argumenta que a doação compulsória de órgãos de condenados à morte deve ser entendida como violação de direitos humanos e não como medida de justiça social. Discute a abrangência do princípio do respeito ao ser humano, abordando a autonomia do indivíduo e sua competência, bem como o sentimento de altruísmo à luz da legislação brasileira e em face da vulnerabilidade dos condenados diante da legislação internacional sobre o tema.

Este artículo pretende debatir la donación compulsoria de órganos de presos condenados a muerte en vista de la demanda de órganos y tejidos que ultrapasa mucho la oferta y genera la necesidad de encontrar medios para aumentar el número de donaciones. Defiende que la donación compulsoria de órganos de condenados a muerte debe ser entendida como una violación de derechos humanos y no como un medio de justicia social. Discute la amplitud del principio del respeto al ser humano, abordando la autonomía del individuo y su competencia, y el sentimiento de altruismo en vista de la legislación brasileña delante de la vulnerabilidad de los condenados delante de la legislación internacional sobre este tema.

This article aims at debating the compulsory donation of organs by death row inmates in view of the demand for organs and tissues for transplants that is far higher than their supply, which leads to necessity of finding ways to increase donations. This article advocates that compulsory donation of organs by death row inmates should be understood as human rights violation, instead of a measure to foster social justice. It discusses the scope of the principle of human respect, approaching individual self-determination and its competence, as well as the feeling of altruism in light of the Brazilian legislation and in view of death row inmates? vulnerability under the international legislation on such theme.

Sexual harassment in the physician-patient interaction: analysis of charges against doctors in the state of São Paulo.

OBJECTIVE: This research intends to discuss sexual harassment within the doctor-patient relationship based on four parameters: doctor's characteristics, accuser's characteristics, accusation characteristics, and the evaluation by the Medicine Council of São Paulo. METHOD: It is a descriptive, quantitative approach using a retrospective documental analysis. Studied subjects were doctors who were allegedly engaged in sexual harassment. This analysis considered all accusations made from January 2000 to December 2005 (n=150). RESULTS: For this type of sexual abuse, there was a prevalence of male professionals (96.6%) who committed abuse against female patients (90.3%) during adulthood (77.7%). The mean age of the accused was 46.87 years, ranging from 30-76 years, concentrated between 46-75 years. The intrinsic difficulty of understanding sexual harassment by a professional constrained ethical evaluation of the cases, with 24.1% of the cases being considered proceeding charges by the professional council. When the cases were recognized as proceeding, they were either filed (88.2%) or were considered to be ethical infringement (11.8%) becoming Professional Ethical Process (PEP). In the majority of proceeding cases (87%), there was a Police Occurrence Report enclosed. DISCUSSION AND CONCLUSION: The incidence of sexual abuse by professionals was independent of education, as the accused professionals came from a large variety of medical colleges, without significant differences related to institution. The predominance of accusations against older professionals may occur due to the frail personality structure that allows professional acting out. Objective evidence is very important in ethical evaluations compared to psychological and subjective evidence.

Sexual harassment in the physician-patient interaction: analysis of charges against doctors in the state of São Paulo

OBJECTIVE: This research intends to discuss sexual harassment within the doctor-patient relationship based on four parameters: doctor's characteristics, accuser's characteristics, accusation characteristics, and the evaluation by the Medicine Council of São Paulo. METHOD: It is a descriptive, quantitative approach using a retrospective documental analysis. Studied subjects were doctors who were allegedly engaged in sexual harassment. This analysis considered all accusations made from January 2000 to December 2005 (n=150). RESULTS: For this type of sexual abuse, there was a prevalence of male professionals (96.6 percent) who committed abuse against female patients (90.3 percent) during adulthood (77.7 percent). The mean age of the accused was 46.87 years, ranging from 30-76 years, concentrated between 46-75 years. The intrinsic difficulty of understanding sexual harassment by a professional constrained ethical evaluation of the cases, with 24.1 percent of the cases being considered proceeding charges by the professional council. When the cases were recognized as proceeding, they were either filed (88.2 percent) or were considered to be ethical infringement (11.8 percent) becoming Professional Ethical Process (PEP). In the majority of proceeding cases (87 percent), there was a Police Occurrence Report enclosed. DISCUSSION AND CONCLUSION: The incidence of sexual abuse by professionals was independent of education, as the accused professionals came from a large variety of medical colleges, without significant differences related to institution. The predominance of accusations against older professionals may occur due to the frail personality structure that allows professional acting out. Objective evidence is very important in ethical evaluations compared to psychological and subjective evidence.

[About correlation between bioethics and medical psychology]. / Sobre a correlação entre a bioética e a psicologia médica.

The authors make a study about the correlation between bioethics and medical psychology. They divide the study in two parts. The first part they discuss the philosophical concepts about the distinction between morals and ethics, they deal with ethics applied to medicine and they are trying to define what is meant by subject and describe its three basic principles: autonomy, beneficence, non maleficence and justice. Consequently in this part they trace route that started from ethics in its philosophical origins and moved on to ethics in its application to medicine. The second part is dedicated to the definition of the field of study of medical psychology, they study some aspects of the emotional relation of the patient with his illness, the relation of the doctors of his medicine and the relationship between doctor and his patient. They discussed some clinical issues where they observe this correlation. At last, they try to draw some conclusions.

Sobre a correlação entre a bioética e a psicologia médica: [revisão] / About correlation between bioethics and medical psychology: [review]

Os autores realizam um estudo a respeito de uma correlação entre a bioética e a psicologia médica. Dividem o trabalho em duas partes. A primeira discute os conceitos filosóficos sobre a distinção entre moral e ética, trata da ética ligada à medicina e dedica-se à bioética, procurando definir o que se compreende por essa disciplina, descrevendo seus três princípios básicos: a autonomia, a beneficência, não-maleficência e a justiça. Portanto, traça nesta parte do trabalho, uma trajetória que partiu da ética em sua vertente filosófica até chegar à ética em sua aplicação à medicina. A segunda parte é dedicada a definição do campo da psicologia médica, estudando aspectos da relação emocional do indivíduo doente com a sua doença, da relação do médico com a medicina e enfoca o relacionamento do médico com seu paciente. Discutem algumas situações clínicas em que se observa essa correlação. No final, buscam elaborar algumas conclusões.

The authors make a study about the correlation between bioethics and medical psychology. They divide the study in two parts. The first part they discuss the philosophical concepts about the distinction between morals and ethics, they deal with ethics applied to medicine and they are trying to define what is meant by subject and describe its three basic principles: autonomy, beneficence, non maleficence and justice. Consequently in this part they trace route that started from ethics in its philosophical origins and moved on to ethics in its application to medicine. The second part is dedicated to the definition of the field of study of medical psychology, they study some aspects of the emotional relation of the patient with his illness, the relation of the doctors of his medicine and the relacionship between doctor and his patient. They discusse some clinical issues where they observe this correlation. At last, they try to draw some conclusions.

Clinical bioethics.

Clinical bioethics was born out of the need to introduce different ethical values involved in the relationships among physician, patient and health institutions which are outside the technical-scientific framework of routine medical practice. Physicians tend to adopt the norms and rules provided for in the Medical Ethics Code to guide the exercising of their professional practice. However, it has recently become challenging to apply these norms to all conduct since some issues faced in the professional practice are simply not provided for by such norms. Ethical consideration in practice drawing solely on the medical ethics code in Brazil has proved insufficient, both in the context of universal issues such as organ transplants, start and end-of-life, as well as in addressing specific issues such as allocation of funds for health. Clinical bioethics employs clinical cases and situations as an instrument for discussion. These discussions entail analysis of not only the facts and circumstances surrounding each case, but also the values which lead to patients, health teams and institutions opting to recommend, accept or refuse a given conduct.

Avaliação das atitudes dos estudantes de medicina frente ao abuso de drogas por colegas do meio acadêmico / Evaluation of medical students' attitudes towards drug abuse by colleagues in the academic environment

CONTEXTO: A prevalência do uso de drogas tem aumentado entre os jovens universitários, trazendo preocupação adicional aos estudantes de medicina que irão se deparar com as conseqüências desse problema durante o período de formação e na prática clínica. OBJETIVOS: Avaliar as atitudes dos estudantes de medicina diante do abuso de drogas por colegas do meio acadêmico, comparando-as quanto às diferentes drogas envolvidas (ilícitas, lícitas e exclusivamente álcool). MÉTODOS: Três versões de um questionário de auto-administração, aprovado pela Comissão de Ética para Análise de Projetos de Pesquisa, foram distribuídas em igual número para diferentes grupos de estudantes de medicina da Faculdade de Medicina da Universidade de São Paulo (FMUSP), sendo o enfoque de cada um deles as drogas lícitas, as ilícitas e o álcool. RESULTADOS: Os resultados mostraram que existe diferença na atitude intervencionista dos estudantes diante do abuso de diferentes drogas. Também houve diferença ao considerarem a participação dos colegas, familiares e profissionais na abordagem do problema e quanto ao plano de tratamento nos casos de abuso. CONCLUSÕES: Os estudantes são mais tolerantes e consideram-se menos vulneráveis ao abuso do álcool, e, portanto, os prejuízos podem não ser percebidos até que haja uma disfuncionalidade incapacitante no campo pessoal e profissional.

BACKGROUND: The prevalence of drug use among young college students is increasing. This gives cause for special concern to medical students who will later confront the consequences of the drug problems both in the classroom as well as in clinical practice. OBJECTIVES: The purpose of this paper is the evaluation of medical students ' attitudes towards drug abuse in the academic environment; comparing these with respect to different kinds of drugs - illegal, legal, and alcohol exclusively. METHODS: Three different versions of a self-completed questionnaire (approved by the Ethics Committee for Research Project Evaluation) were ministered to groups of equal numbers of medical students attending the University of Sao Paulo, School of Medicine - FMUSP (Brazil). Each questionnaire focused on illegal drugs, legal drugs, and alcohol. RESULTS: The results indicated a significant difference in the students ' attitudes regarding intervention for the different types of drug abuse. There was also indication of a difference in the students ' opinions regarding the roles that colleagues, relatives, and health professionals undertake in dealing with these issues, including the respective treatment plans for drug abuse. CONCLUSIONS: Medical students tend to be more tolerant of alcohol consumption, considering themselves to be less vulnerable to alcohol abuse. Therefore, harmful consequences may not be apparent until an incapacitating level of dysfunction affects the individual on both a personal and professional level.

Como ensinar a bioética / How to Teach Bioethics

O ser humano não nasce nem humano e nem ético ou anti-ético; ele nasce aético, com a possibilidade de se humanizar. E é através desse processo de humanização que ele pode se tornar ético. O que caracteriza o humano é a cultura enquanto fenômeno simbólicos, sendo a bioética um fenômeno da cultura. Podemos dizer que a bioética emerge das relações psicossociais. Ser bioético quer dizer, lidar com os conflitos entre os instintos (sexuais), as pulsões (sexualidade) e a realidade, ou seja, lidar com os conflitos entre o ser natural e o ser cultural, integrando a sua biologia com a sua biografia, que é sempre única. Uma das principais funções da Universidade será a de permitir que seus alunos, professores e demais funcionários possam pensar as questões de bioética, e com esta finalidade estamos criando o Núcleo de Bioética da USP. Este núcleo tem o propósito de ampliar as discussões e o ensino de bioética com toda a comunidade uspiana. Por outro lado, frente as questões do ensino da bioética, a Faculdade de Medicina da USP deu início a uma série de encontros com os professores responsáveis de algumas disciplinas da graduação, que mesmo estando em outros departamentos da faculdade, estavam estritamente ligadas a uma formação humana dos estudantes, como as Disciplinas: Bases Humanística da Medicina I e II, Psicologia Médica, Cidadania e Medicina, Bioética e Bioética Clínica. Esta discussão passa pela possibilidade de se ter um eixo, que seja um continuum trasnversal, na formação do médico e não apenas disciplinas pontuais nas quais o estudante tenha dificuldade em articulá-las. Existe também o projeto Tutores com esta mesma finalidade. Para finalizar gostaria de salientar que o conhecimento da anatomia humana não nos permitiu localizar qual é a parte do corpo onde se localiza nossa alma; do mesmo modo, acredito que não será o mapeamento do genoma que nos transformará em diabos ou desuse, pois estas questões humanas são muito complexas, difícieis de serem avaliadas pelo método científico. Entendo que não será função da bioética saber para onde caminha a humanidade, mas sim será função da bioética pensar, discutir e ensinar este caminho de uma forma mais humana, podendo-se assim decidir sobre nosso futuro.