Ethics competences in the undergraduate medical education curriculum: the Spanish experience.

Aim .To investigate if there are differences in medical ethics education between different schools of medicine in Spain, specifically between private and public schools and between recently founded schools and older ones. METHOD: The curricula of medical degrees from all Spanish faculties were reviewed for the 2014/2015 academic year, identifying subjects concerning bioethics, deontology, and ethics. We identified the type of teaching, format and method of the course, the number of credits and hours, and the school year of each subject. An analysis with descriptive parameters and the Cohen's coefficient (d) was performed. RESULTS: All medical schools in Spain (n=44) were included. A mean of 3.64 European Credit Transfer and Accumulation System (ECTS) credits was specifically devoted to ethical values teaching in Spain. Private medical schools offered more credits than public ones (6.51 ECTS vs 2.88 ECTS, relevant difference: d=2.06>>0.8), and the 10 most recently founded medical schools offered more credits than the 10 oldest (5.86 ECTS vs 2.63 ECTS, relevant difference: d=1.43>0.8). A mean of 36.75 hours was dedicated to ethics education. CONCLUSIONS: Although ethics education is incorporated into the training of future Spanish physicians, there is still notable heterogeneity between different medical schools in the time devoted to this topic.

Normality and mental health: The ethical dimension / Normalidad y salud mental: La dimensión ética

Abstract This article applies the concept of normality, in both its descriptive and normative connotations, to the field of mental health, emphasizing its ethical undertones in different cultural and situational contexts. Ethics is defined as the linguistic justification of morals, and bioethics is characterized by arguments based on dialogical, discursive, and deliberative processes. Bioethical decision-making influences human relationships and has implications for diagnosis, prognosis, interventions, and evaluation of therapeutic results and outcomes. Normality in mental health should be reformulated on bioethical principles to avoid being a source of stigma and discrimination, at a time when human diversity and cultural change impose a redefinition of conceptual boundaries and depathologization of different forms of behavior and experience.

Resumen Se aplica el concepto de normalidad en sus connotaciones descriptiva y normativa al campo de la salud mental, destacando su tonalidad ética en diferentes contextos culturales y situacionales. Se define la ética como la justificación lingüística de la moral y se caracteriza a la bioética como fuente de argumentos basados en procesos dialógicos, discursivos y deliberativos. La toma de decisiones en clave bioética influencia las relaciones humanas y posee implicaciones para el diagnóstico, el pronóstico, las intervenciones y la evaluación de resultados y consecuencias. La normalidad en salud mental debiera ser reformulada sobre la base de principios bioéticos a fin de impedir ser fuente de estigma y discriminación en una época en que la diversidad y el cambio cultural imponen una redefinición de límites conceptuales y la despatologización de diferentes formas de conducta y vivencia.

Bioethics and advance directives in psychiatric in the hospital context / Bioética y directrices anticipadas en psiquiatría en el contexto hospitalario

Abstract Introduction Mental health services have been a focus of human rights advocates and recent legal reforms in some Latin American countries, which have called for a change from the paradigm of hospitalization to one of accompanying and supporting the person with mental health issues, which make it possible to apply the Advance Directives in Psychiatry (PADs). This change will require time, as well as economic, material, and human resources, and transformations in attitudes, culture, and society, but the implementation of PADs cannot be postponed: they must be used to protect the autonomy of the persons affected, within a bioethical framework. Objective Identify possible bioethical conditions in the prevailing conventional hospital context in Latin America that allow for an implementation of PADs. Method A participant-observer study was carried out in two psychiatric hospital services from June to September 2022. Results A thematic analysis found three themes: 1) clinical care, 2) patient predisposition, and 3) medical-legal questions. This study considered part of theme 2, including the following sub-themes: a) patient self-perception, b) biography/narrative versus diagnostic classification, and c) negotiation. Discussion and conclusion Prominent among the sub-themes discussed are recognition of the values of autonomy and its elements in all of the expressions of the person with mental illness, as well as actions of the physician or health care team in synergy with supported decision-making, a distinctive feature of the anticipatory process of the PAD.

Resumen Introducción La atención de la salud mental se ha visto emplazada por los Derechos Humanos y las recientes reformas legales en algunos países latinos, que instan a cambiar el paradigma asistencial de la hospitalización al del acompañamiento y apoyo en la toma de decisiones de la persona en condición mental, que posibilitan la aplicación de las Directrices Anticipadas en Psiquiatría (DAP). Este cambio implica tiempo, recursos económicos, materiales y humanos, transformaciones actitudinales, culturales y sociales. No obstante, la implementación de las DAP no puede postergarse, deben aplicarse basadas en el respeto a las personas en un marco bioético. Objetivo Identificar las condiciones bioéticas posibles en el contexto hospitalario convencional, imperante en los países de América Latina, que permitan la implementación de las DAP. Método Se llevó a cabo una observación participante en dos servicios de hospitalización psiquiátrica, entre junio y septiembre de 2022. Resultados A través de un análisis temático se obtuvieron tres temas: 1) atención clínica, 2) predisposición de los pacientes y 3) asuntos médicos-legales. Este estudio consideró sólo una parte del tema 2 con sus subtemas: a) Autopercepción de los pacientes, b) biografía/narrativa versus clasificación y c) negociación. Discusión y conclusión En los subtemas discutidos se resalta el reconocimiento a los valores de la autonomía y sus elementos presentes en todas las manifestaciones de la persona con enfermedad mental, se reconoce también el actuar del médico o equipo de salud en sinergia con la toma de decisiones apoyada, que distingue el proceso anticipatorio de las DAP.

Las humanidades en la formación profesional / The humanities in professional training

Bajo el término humanidades solía entenderse en el Renacimiento europeo el cultivo de las perfecciones atribuidas a la Antigüedad clásica. Más ampliamente, el término designa aquellas disciplinas y saberes que complementan las actividades lucrativas con sensibilidad estética, conciencia histórica y discernimiento ético.

La psicoética de lo sindémico: lo pático y la patológico / The psychoethics of syndemic: the pathic and the pathological / A psicoética da sindemia: o pático e o patológico

Resumen Tras discutir el alvance y las implicaciones de la expresión "salud mental" tanto a nivel individual como social, este artículo destaca que el sufrimiento (como condición pática) no siempre es patológico en sentido médico y debería ser considerado al evaluar las respuestas a la sindemia (resultado sinérgico de muchas alteraciones en el medio social) causada por covid-19. Teniendo como trasfondo las dimensiones de experiencia y expectativa de las sociedades, el substrato dialógico del pensamiento bioético es refraseado como una psicoética que incorpora una evaluación de las respuestas que manifiesta el público, los comunicadores y las autoridades. Se refuerza la necesidad de un situacionismo empírico en la deliberación moral y la demanda de una axiología empírica en la cual los juicios se hagan después de contrastar continuamente valores, principios y normas con la conducta real de las personas.

Abstract After discussing the scope and implications of the expression "mental health" at both the individual and social levels, this paper emphasizes that suffering (a pathic condition) is not always pathological in medical terms, and should be taken into consideration when evaluating the responses to the syndemic (the synergistic outcome of many alterations of the social milieu) caused by Covid19. Against the background of the historical-anthropological dimensions of experience and expectation of societies, the dialogical underpinning of bioethical thinking is rephrased as a psychoethics that incorporates an evaluation of the responses affecting the public, the communicators, and authorities. This reinforces the need for an empirical situationism in moral deliberation and the demand for empirical axiology in which judgments are made after continuous contrasting values, principles, and norms with the actual behavior of people.

Resumo Depois de discutir o âmbito e as implicações da expressão "saúde mental" tanto a níveis individual e social, esse artigo enfatiza que o sofrimento (uma condição pática) nem sempre é patológico em termos médicos e deve ser levado em consideração quando se avalia as respostas ao sindêmico (o desfecho sinérgico de muitas alterações do ambiente social) causado pela Covid19. Contra o pano de fundo das dimensões histórico-antropológicas da experiência e expectativa das sociedades, a sustentação dialógica do pensamento bioético é refraseado como uma psicoética que incorpora uma avaliação das respostas que afetam o público, os comunicadores e as autoridades. Isto reforça a necessidade de um situacionismo empírico na deliberação moral e a demanda para uma axiologia empírica na qual julgamentos são feitos depois de contrastar continuamente valores, princípios e normas com o comportamento real de pessoas.

[Commentary note on the Italian translation of the Council for International Organizations of Medical Sciences 2002 Guidelines]. / Note di commento alla traduzione italiana delle linee guida del 2002 del Consiglio delle Organizzazioni Internazionali delle Scienze Mediche (CIOMS).

The new CIOMS International Ethical Guidelines on Biomedical Research Involving Human Subjects were published in August 2002. The aim of the present paper was to prepare a reasoned Italian translation of the guidelines. A preliminary version was submitted to a group of bioethicists and scientific research experts. Besides verifying the correctness and the adherence of the Italian version to the original text, a number of problematic terms were analysed. Some uncertainties emerged about the translation of expressions such as "ethical review committee" and "sponsor" and the difficulty to distinguish between "should" and "must". In the present globalisation era the need was apparent for a new approach to produce faithful translations based on a multidisciplinary approach that takes into account specific contexts and local peculiarities, but remains respectful to the original text.

The hermeneutical dimension of the bioethical enterprise: notes on the dialogical/narrative foundations of bioethics / La dimensión hermenéutica de la empresa bioética: notas sobre el fundamento dialógico/narrativo de la bioética / A dimensão hermenêutica da empresa bioética: notas sobre a narrativa dialógica dos fundamentos da bioética

Resumen: Based on the challenges posed by the scientific activity of the author, related to the integration and harmonization of heterogeneous discourses, a hermeneutic framework for bioethics is stressed. It is mainly concerned with elucidating intentions, hidden meanings, and motivations of texts and behaviors that can be converted into texts. Equating the mimetic circle of Paul Ricoeur with the hermeneutical circle is advocated as a practical application. The importance of the hermeneutic approach suggests that it can also be applied to written productions in bioethics, since the history of this intellectual endeavor can be reformulated considering a reinterpretation of its record.

Abstract: Basándose en los desafíos de su propia trayectoria científica, relacionados con la integración y la armonización de discursos heterogéneos, se destaca el marco de referencia hermenéutico para la bioética. Se relaciona con dilucidar intenciones, significados ocultos y motivaciones de textos y conductas que pueden ser convertidas a textos. Equiparar el círculo mimético de Paul Ricoeur con el círculo hermenéutico se propone como una aplicación práctica. La importancia de la aproximación hermenéutica sugiere que también puede aplicarse a las producciones escritas de la bioética, ya que la historia de esta disciplina puede reformularse considerando una reinterpretación de su registro.

Resumo: Baseado nos desafios decorrentes da atividade científica do autor, relacionados à integração e harmonização dos discursos heterogêneos, quadro hermenêutico para a Bioética é traçado. E sua preocupação central está em elucidar intenções, significados ocultos, motivações dos textos e comportamentos que podem ser convertidos em textos. Igualar o círculo mimético de Paul Ricoeur com o círculo hermenêutico é defendida como uma aplicação prática. A importância da abordagem hermenêutica sugere que pode também ser aplicada às produções escritas em Bioética, desde que a história deste empreendimento intelectual pode ser reformulada considerando uma reinterpretação de seu registro.