María de la Luz Casas Martínez

Dilemas bioéticos y sus posibles soluciones en las unidades de terapia intensiva pediátrica del Distrito Federal (México)

El proceso de toma de decisiones en las unidades de terapia intensiva pediatrica (UTIP) se sustenta en un marco cientifico, legal y etico, el cual suele ser mas complejo que en la practica para adultos e involucra a los padres o tutores, en consecuencia, debe ser resuelto con seriedad, con calma y rigor metodologico. Se diseno una encuesta por expertos, con aplicacion anonima y voluntaria, en forma no institucional, en la que se plantearon cuestiones referentes a dilemas bioeticos generados en los servicios de UTIP y los procedimientos para su solucion. La aplicacion de este instrumento fue el metodo Delphi, en dos rondas. Los resultados mas importantes, entre otros, consistieron en reconocer que la totalidad de los medicos encuestados enfrentan en su unidad dilemas eticos, siendo el mas frecuente la obstinacion terapeutica, en un 32%, resultado que se enlaza al de la dificultad de establecer el diagnostico de paciente terminal, en un 13%. Incluir materias de bioetica y toma de decisiones con contenido moral en la formacion de estos profesionistas, asi como implementar la comunicacion asertiva entre el equipo de salud y la familia, y promover el funcionamiento adecuado de comites de bioetica hospitalarios con funciones consultivas de emergencia, son propuestas que emergen de las conclusiones de este estudio.The process of decision making in pediatric intensive therapy units (PITU) is based on an ethical, legal and scientific framework, which generally is more complex that with adults and involves parents or tutors, thus, it must be solved carefully, with time and methodological precision. A survey was design for experts with anonymous and voluntary application, in a non institutional way, in which questions arise referring to bioethical dilemmas generated in PITU services and proceedings for their solution are proposed. Delphi method was used as instrument in two rounds. The most important results, among others, consisted in recognizing that all physician surveyed face in their unit ethical dilemmas, the most frequent being obstinacy in therapy in 32% cases, result linked to the difficulty to establish the diagnosis of terminal patient in 13% cases. To include bioethics topics and decision making with moral content in training professionals, as well as implementing assertive communication among health care team and families, and promoting adequate functioning of hospital bioethics committees with emergency consulting functions, are proposals which arise from the conclusions of this study.

Introducción a la metodología de la investigación en bioética. Sugerencias para el desarrollo de un protocolo de investigación cualitativa interdisciplinaria

Resumen es: El avance de la bioetica requiere de la ciencia para su desarrollo. La investigacion en bioetica parte de la interdisciplinariedad, lo cual complica su ...

Bioethics dilemmas and their possible solutions in pediatric intensive therapy units of Federal District (Mexico)

El proceso de toma de decisiones en las unidades de terapia intensiva pediatrica (UTIP) se sustenta en un marco cientifico, legal y etico, el cual suele ser mas complejo que en la practica para adultos e involucra a los padres o tutores, en consecuencia, debe ser resuelto con seriedad, con calma y rigor metodologico. Se diseno una encuesta por expertos, con aplicacion anonima y voluntaria, en forma no institucional, en la que se plantearon cuestiones referentes a dilemas bioeticos generados en los servicios de UTIP y los procedimientos para su solucion. La aplicacion de este instrumento fue el metodo Delphi, en dos rondas. Los resultados mas importantes, entre otros, consistieron en reconocer que la totalidad de los medicos encuestados enfrentan en su unidad dilemas eticos, siendo el mas frecuente la obstinacion terapeutica, en un 32%, resultado que se enlaza al de la dificultad de establecer el diagnostico de paciente terminal, en un 13%. Incluir materias de bioetica y toma de decisiones con contenido moral en la formacion de estos profesionistas, asi como implementar la comunicacion asertiva entre el equipo de salud y la familia, y promover el funcionamiento adecuado de comites de bioetica hospitalarios con funciones consultivas de emergencia, son propuestas que emergen de las conclusiones de este estudio.The process of decision making in pediatric intensive therapy units (PITU) is based on an ethical, legal and scientific framework, which generally is more complex that with adults and involves parents or tutors, thus, it must be solved carefully, with time and methodological precision. A survey was design for experts with anonymous and voluntary application, in a non institutional way, in which questions arise referring to bioethical dilemmas generated in PITU services and proceedings for their solution are proposed. Delphi method was used as instrument in two rounds. The most important results, among others, consisted in recognizing that all physician surveyed face in their unit ethical dilemmas, the most frequent being obstinacy in therapy in 32% cases, result linked to the difficulty to establish the diagnosis of terminal patient in 13% cases. To include bioethics topics and decision making with moral content in training professionals, as well as implementing assertive communication among health care team and families, and promoting adequate functioning of hospital bioethics committees with emergency consulting functions, are proposals which arise from the conclusions of this study.

Selección de sexo: avances e implicaciones éticas

Resumen La seleccion de sexo es una practica que se ha desarrollado en distintos paises con objetivos diferentes. En ciertos paises, esta practica obedece a discriminacion por razones de sexo; en otros, se emplea para evitar enfermedades de transmision hereditaria. Independientemente de los objetivos que se persigan con la seleccion de sexo; su finalidad es que con ella se puede favorecer la eliminacion de los seres humanos cuyo sexo no obedece a los criterios de salud o preferencia de sexo establecidos. Por tanto, se trata de una practica eticamente discutible que, sin embargo, goza de inmunidad juridica en algunas legislaciones que, en ocasiones, tratan de plantearla como una alternativa terapeutica. Con respecto a esto, conviene enfatizar que la nocion de “discriminacion” consolidada en los diferentes textos internacionales alude siempre a una distincion de caracter inaceptable, basada en caracteristicas personales o situaciones sociales ajenas a la responsabilidad del sujeto, que le suponen un perjuicio o una desventaja, ademas de un ataque a su dignidad. Por tanto, la seleccion de sexo caprichosa lleva consigo una eleccion previa a la propia concepcion, sobre la base de unos estereotipos reveladores de prejuicios injustificados en los ninos o las ninas.

Introduction to investigation's methodology in bioethics, hints for the developmento of an interdisciplinary qualitative protocol

Resumen es: El avance de la bioetica requiere de la ciencia para su desarrollo. La investigacion en bioetica parte de la interdisciplinariedad, lo cual complica su ...

Prejudice, stereotypes and discrimination. Ethical and psychodynamic reflection on embryonic sex selection

La eleccion de sexo embrionario es una posibilidad biotecnologica que por ser realizada sobre gametos no causa dano al cigoto. La eleccion del sexo de los hijos podria ser inocua pero, para que fuera libre, deberia estar exenta de presiones psicologicas, especificamente de sentimientos de discriminacion como sintoma neurotico. El articulo senala las bases de este sintoma y sus manifestaciones. Existe una gran responsabilidad cuando se toman decisiones que afectan a terceros y es necesario que se realicen con el mas alto grado posible de libertad. En este trabajo tambien se analizan las alternativas, prevencion y manejo de la discriminacion neurotica.Resumen es: La eleccion de sexo embrionario es una posibilidad biotecnologica que por ser realizada sobre gametos no causa dano al cigoto. La eleccion del sexo de lo...

The consideration of the subject participant in research as active part in the pharmaceutical business

Although for thirty years researchers involved in biomedical investigation have designed international strategies for the protection of the subject of investigation, the consideration of the patient as an active subject in the pharmaceutical business in practice is minimized. One of these compromises in the patients protection is contained in the Helsinki VI Declaration, in which the laboratory accepts to continue the supply of the medicament and/or method studied post- protocol, when this has been proved to be a benefit to the participant in the research, in practice, this is not fulfilled. Bioethics, as a pro- dialog discipline, tries to approach the involved sectors looking for languages or common points of view in order to have agreements. That is why I, in the present work, used the pharmaceutical laboratorys own arguments, commercial laws and general ethics.Although for thirty years researchers involved in biomedical investigation have designed international strategies for the protection of the subject of investigation, the consideration of the patient as an active subject in the pharmaceutical business in practice is minimized. One of these compromises in the patients protection is contained in the Helsinki VI Declaration, in which the laboratory accepts to continue the supply of the medicament and/or method studied postprotocol, when this has been proved to be a benefit to the participant in the research, in practice, this is not fulfilled. Bioethics, as a pro- dialog discipline, tries to approach the involved sectors looking for languages or common points of view in order to have agreements. That is why I, in the present work, used the pharmaceutical laboratorys own arguments, commercial laws and general ethics.

LA CONSIDERACIÓN DEL SUJETO DE INVESTIGACIÓN COMO PARTE ACTIVA EN LA EMPRESA FARMACÉUTICA

Although for thirty years researchers involved in biomedical investigation have designed international strategies for the protection of the subject of investigation, the consideration of the patient as an active subject in the pharmaceutical business in practice is minimized. One of these compromises in the patients protection is contained in the Helsinki VI Declaration, in which the laboratory accepts to continue the supply of the medicament and/or method studied post- protocol, when this has been proved to be a benefit to the participant in the research, in practice, this is not fulfilled. Bioethics, as a pro- dialog discipline, tries to approach the involved sectors looking for languages or common points of view in order to have agreements. That is why I, in the present work, used the pharmaceutical laboratorys own arguments, commercial laws and general ethics.Although for thirty years researchers involved in biomedical investigation have designed international strategies for the protection of the subject of investigation, the consideration of the patient as an active subject in the pharmaceutical business in practice is minimized. One of these compromises in the patients protection is contained in the Helsinki VI Declaration, in which the laboratory accepts to continue the supply of the medicament and/or method studied postprotocol, when this has been proved to be a benefit to the participant in the research, in practice, this is not fulfilled. Bioethics, as a pro- dialog discipline, tries to approach the involved sectors looking for languages or common points of view in order to have agreements. That is why I, in the present work, used the pharmaceutical laboratorys own arguments, commercial laws and general ethics.