Claudio Cohen

Sobre a correlação entre a bioética e a psicologia médica

Os autores realizam um estudo a respeito de uma correlacao entre a bioetica e a psicologia medica. Dividem o trabalho em duas partes. A primeira discute os conceitos filosoficos sobre a distincao entre moral e etica, trata da etica ligada a medicina e dedica-se a bioetica, procurando definir o que se compreende por essa disciplina, descrevendo seus tres principios basicos: a autonomia, a beneficencia, nao-maleficencia e a justica. Portanto, traca nesta parte do trabalho, uma trajetoria que partiu da etica em sua vertente filosofica ate chegar a etica em sua aplicacao a medicina. A segunda parte e dedicada a definicao do campo da psicologia medica, estudando aspectos da relacao emocional do individuo doente com a sua doenca, da relacao do medico com a medicina e enfoca o relacionamento do medico com seu paciente. Discutem algumas situacoes clinicas em que se observa essa correlacao. No final, buscam elaborar algumas conclusoes.

Time variation of some selected topics in bioethical publications

Objective: To analyse the time variation of topics in bioethical publications as a proxy of the relative importance. Methods: We searched the Medline database for bioethics publications using the words “ethics or bioethics”, and for 360 specific topics publications, associating Medical Subject Heading topic descriptors to those words. We calculated the ratio of bioethics publications to the total publications of Medline, and the ratio of each topic publications to the total bioethics publications, for five-year intervals, from 1970 to 2004. We calculated the time variation of ratios, dividing the difference between the highest and lowest ratio of each topic by its highest ratio. Four topics were described, selected to illustrate different patterns of variation: “Induced Abortion”, “Conflict of Interest”, “Acquired Immunodeficiency Syndrome”, “Medical Education.” Results: The ratio of bioethics publications to total Medline publications increased from 0.003 to 0.012. The variation of the topic’s ratios was higher than 0.7 for 68% of the topics. The Induced Abortion ratios decreased from 0.12 to 0.02. Conflict of Interest ratios increased from zero to 0.07. The Acquired Immunodeficiency Syndrome ratios were nearly zero in the first three intervals, had a peak of 0.06 during 1985–9, followed by a decrease to 0.01. Medical Education ratios varied few, from 0.04 to 0.03. Conclusions: There was an increase of bioethical publications in the Medline database. The topics in bioethics literature have an important time variation. Some factors were suggested to explain this variation: current legal cases, resolution of the issue, saturation of a discussion and epidemiologic importance.

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.

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

BackgroundOne 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 bodyThe 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.ConclusionHopefully, 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.

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

Análisis de la dignidad criminal y la falta de protección penal en relación con la investigación en seres humanos

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

Analysis of criminal dignity and the lack of criminal protection in relation to research involving human beings

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