Responsabilidad penal médica: consideraciones en la aplicación del principio del doble efecto / Medical Criminal Liability: considerations in the application of the principle of double effect

La responsabilidad médica en Chile contempla un espacio de discrecionalidad, en situaciones de peligro para la mujer durante el embarazo y en el tratamiento paliativo de pacientes terminales. En estos casos se presentan conceptos jurídicos indeterminados, en el ordenamiento jurídico chileno, que requieren de una propuesta interpretativa en consonancia con la protección del derecho a la vida, en actividades médicas que tengan por efecto colateral la muerte de personas inocentes (AU).

The chilean medical liability leaves a room of discretion in cases when a hazardous condition exists during the pregnancy or palliative care for those dying from a terminal disease. In such cases, the Chilean legal system presents undefined legal concepts. This concepts need to be in accordance with the promotion of the constitutional right to life, in medical cases where innocent people could die by side effect (AU).

Double trouble: Addressing stunting and obesity via school nutrition

Background. South Africa (SA), as a middle-income country, faces the nutrition transition and associated double burden of undernutrition and obesity. School feeding programmes are one way of ensuring that malnutrition in children is addressed, but questions remain about whether they can address both undernutrition and obesity.Objectives. To compare the obesity and stunting outcomes for children receiving different combinations of school feeding programmes in a rural district of SA.Methods. The evaluation involved a comparative design that compared the stunting obesity levels of three groups of children. Group 1 received one lunch meal a day for a prolonged period, group 2 both lunch and breakfast, and group 3 had started receiving a daily lunch shortly before the commencementofthresearch.Results. Group 1 had stunting levels in line with the national average. Group 2 had lower stunting levels than those receiving only the lunch meal. Children from group 3 had lower stunting levels than groups 1 and 2. Rates of obesity and overweight were markedly different between the groups. Group 3 had very high rates of overweight and obesity ­ above the national average of 28%. In contrast, group 1 had far lower rates of overweight and obesity, and group 2exhibited the lowest levels. There was a significant decrease in the percentage of learners classified as overweight in group 3 over the 6-month period, from 26.1% to 19.2%.Conclusion. One lunch meal a day is associated with positive outcomes in relation to rates of stunting and obesity, and the lowest rates of obesity were measured when a breakfast meal was added. The addition of a breakfast meal to a lunch feeding programme shows promise,but this requires further investigation to understand whether causal linkages exist

Aproximación ética científica al doble efecto o único bien posible en el aborto terapéutico / Scientific ethical approach to double effect or only possible good in therapeutic abortion / Aproximação ética científica ao duplo efeito ou único bem possível no aborto terapêutico

El estudio muestra como la doctrina o principio del doble efecto (DDE) de una acción con efecto secundario negativo no puede aplicarse a todos los casos de aborto terapéutico (AT). Con el análisis de las causas e indicación de AT se demuestra que solo algunos de estos corresponden a DDE. Cuando no es el feto el que lleva a la madre a tener un embarazo de alto riesgo con amenaza de daño severo o muerte para ella, el caso puede adscribirse a la DDE; cuando es el feto directa o indirectamente el que causa a lleva a ese riesgo materno, el caso no se adscribe a la DDE. Si el feto es la causa de la muerte inminente de la madre, la remoción de la causa, que es la terapia adecuada, coincide con matarlo; entonces la acción buena (salvar a la madre tratándola causalmente) es la misma que la mala (matar al feto), situación que no puede asimilarse sea a la DDE o a la doctrina del mal menor. Más aún, decidir no interrumpir el embarazo produciría la muerte de la madre y el feto. El caso debería adscribirse al principio del único bien posible.

This study shows the inapplicability of the doctrine of double effect (DDE) to all the cases of therapeutic abortion (TA). The causes of the maternal risk define cases that cannot be included in the DDE. When it is not the embryo or fetus that produces the mother pathology the case can be assigned to the DDE. When the embryo or fetus produces directly or indirectly the process that threatens the mother’s life the case cannot be assigned to the DDE. If the fetus is the cause of the imminent mother’s death, the removal of the cause, that is the proper therapy, coincides with killing him or her; then the good action (to save therapeutically the mother) is the same to the bad action (to kill the fetus) and this situation cannot be assimilated either to the DDE or to the doctrine of the lesser evil. Deciding not to kill the fetus will produce the death of the mother and the fetus. So this situation should be ascribed to the principle of the unique possible well.

O estudo mostra como a doutrina ou princípio do duplo efeito (DDE) de uma ação com efeito secundário negativo não pode aplicar-se a todos os casos de aborto terapêutico (AT). Com a análise das causas e indicação de AT se demonstra que só alguns destes correspondem a DDE. Quando não é o feto que leva a mãe a ter uma gravidez de alto risco com ameaça de dano severo ou morte para ela, o caso pode circunscrever-se à DDE; quando é o feto direta ou indiretamente quem causa ou leva a esse risco materno, o caso não se circunscreve a DDE. Se o feto é a causa da morte iminente da mãe, a remoção da causa, que é a terapia adequada, coincide em matá-lo; então a ação boa (salvar a mãe tratando-a causalmente) é a mesma que a má (matar o feto), situação que não pode assimilar-se à DDE ou à doutrina do mal menor. Mais ainda, decidir não interromper a gravidez produziria a morte da mãe e do feto. O caso deveria circunscrever-se ao princípio do único bem possível.

¿Qué es el aborto indirecto?: la prohibición del aborto y el principio del doble efecto / O que é o aborto indireto?: a proibição do aborto e o principio do duplo efeito / What is indirect abortion?: the prohibition of abortion and the principle of double effect

Este trabajo estudia la distinción entre "aborto directo" y "aborto indirecto". El propósito del autor es clarificar el sentido de esta distinción y mostrar que existen argumentos filosóficos sólidos para justificar su relevancia moral. Para lograr este objetivo expone, en primer lugar, el principal argumento esgrimido por quienes consideran el aborto (directo) como un acto intrínsecamente injusto; en segundo, muestra cuál es el origen histórico de la distinción entre aborto directo y aborto indirecto; en tercero, presenta un argumento para defender la relevancia moral de esta distinción y, finalmente, explica el modo en que ella opera, usando como ejemplo el análisis de T. L. Bouscaren sobre la salpingectomía de una trompa con feto ectópico.

This paper study the distinction between "direct abortion" and "indirect abortion". The purpose of the author is to clarify the meaning of the distinction and to show that there are solid philosophical arguments to justify moral relevance. In order to achieve this goal, first, the main argument expressed by those who consider abortion (direct) as an act intrinsically unfair is exposed; second, the historical origin of the distinction between direct and indirect abortion is shown; third, an argument defending the moral relevance of this distinction is presented; and, finally, the way it operates is explained by the analysis of T. L. Bouscaren about salpingectomy of a fallopian tube with ectopic fetus.

Este trabalho estuda a distinção entre "aborto direto" e "aborto indireto". O propósito do autor é clarear o sentido desta distinção e mostrar que existem argumentos filosóficos sólidos para justificar sua relevância moral. Para lograr este objetivo expõe, em primeiro lugar, o principal argumento esgrimido por aqueles que consideram o aborto (direto) como um ato intrinsecamente injusto; em segundo, mostra qual é a origem histórica da distinção entre aborto direto e aborto indireto; em terceiro, apresenta um argumento para defender a relevância moral desta distinção e, finalmente, explica o modo pelo qual ela opera, usando como exemplo a análise de T. L. Bouscaren sobre a salpingectomia de uma trompa com feto ectópico.

Consentimiento informado en la nueva ley de derechos de los pacientes / Informed consent in the patients' rights law

Background: The new regulation of patients' rights creates the right to informed consent, which allows accepting or refusing any medical treatment. Also, the patient has the right to be appropriately informed about a variety of aspects determined by the law. Patient's autonomy has limits. Artificial acceleration of death, euthanasia or assisted suicide are not permitted. The problem is that the law does not define those situations. The law provides the intervention of Ethics Committees when the doctor considers that the patient exposes himself to severe harm or the risk of death which would be avoided. This intervention impinges on patient's autonomy. Patients have the right to request discharge and medical facilities could discharge patients against their will if they do not accept medical recommendations. These limitations on autonomy should be explained because the law apparently makes the distinction between killing, letting die and the Double Effect Doctrine. There is plenty of literature questioning the validity of both. The law fails to regulate part of the medical practice, regarding life and death decisions. A lack of consensus could explain this omission. Doctors have a right to conscientious objection to some patient's requests.

Matar, dejar morir y eutanasia en el proyecto de ley sobre derechos de las personas y en la doctrina chilena / To kill, let die and euthanasia in the bill of rights of patients and in the Chilean doctrine

The Bill of Rights for Patients provides the patient with autonomy for disposing of his life, enabling him to reject those treatments that unnecessarily prolong his life. However, the bill does not allow an artificial acceleration of death. Therefore, the bill does not permit euthanasia (at least, certain form of it) nor assisted-suicide. However, according to the practice of medicine and also Chilean doctrine, it is permitted to inject morphine to a patient to relieve his pain, even though that could hasten his death. In consequence, it is allowed for the patient to dispose of his life and also to inject in him morphine for pain relief, endangering his life, but neither euthanasia nor assisted-suicide is allowed. Is this coherent? According to Chilean doctrine, it could be coherent under the condition of accepting the distinction between killing and letting die and also the double effect doctrine. The problem is that there is abundant English literature in the realm of moral philosophy to disregard both conditions. Therefore, it is possible to claim that the Bill is not coherent and that the Chilean doctrine is based upon a distinction and a doctrine that are not acceptable.