Lithotomy's prohibition and referral to experts in medical oaths of hippocratic stemma. / Prohibición de la litotomía y derivación a expertos en los juramentos médicos de la genealogía hipocrática.

OBJECTIVE: The aim is to analyse how the Hippocratic Oath's commitments of not cutting for stone and referral to experts was modified in medical oaths of Hippocratic stemma from different time periods. METHODS: Nineteen oaths of Hippocratic stemma were studied: 4 Medieval, 2 Modern, and 13 Contemporary. They were selected according to: name of the oath when it includes the word «Hippocratic¼ or because their authors recognized having based their oaths on the Hippocratic Oath. Their historical significance and representativity regarding time period, renowned medical schools, and importance and reliability of the sources was also taken into consideration. RESULTS: Four oaths prohibit cutting for stone (one Medieval, 2 Modern, one Contemporary); 4 oaths mention seeking consultation about patients (all Contemporary); 3 mention not performing criminal operations (all Contemporary); 8 do not mention these commitments (3 Medieval, 5 Contemporary). CONCLUSION: The commitment of the Hippocratic Oath of not cutting for stone and referral to experts has been modified mainly in Contemporary oaths. The original commitment seems to have been split into 2 tendencies: those that mention obtaining consultation, and those that refer to not performing criminal operations. Due to the bioethics movement in the second half of the 20th century, referring patients that exceed the physician's limitations to more skilled colleagues constitutes an ethical obligation. Thus, it should be a commitment present in every Contemporary oath.

Doctor-patient sexual relationships in medical oaths.

BACKGROUND: Doctor-patient sexual relationship is considered to be unfair because the first party would be abusing the second party's vulnerability. The prohibition of this relationship is noted in the Hippocratic oath. Currently, a reprise of the use of oaths in medical schools can be observed. AIM: To determine whether the prohibition has been maintained and how its expression has varied in the oaths during different periods. METHODS: 50 oaths were studied: 13 ancient-medieval and 37 modern-contemporary. Of the 50 texts, 19 were versions of the original oaths. The oaths that pointed out the prohibited doctor-patient relationship referred to any sexual aspect or included paragraphs that began as the Hippocratic oath does were noted. RESULTS: Of the 24 (48%) texts that expressed the prohibition, 8 (62%) were ancient-medieval and 16 (43%) were modern-contemporary. Some expressly call it Hippocratic oath, many use general terminology (corruption or vice) and others describe it in association with other commitments (abortion and euthanasia). CONCLUSIONS: The clause on the prohibition of the doctor-patient sexual relationship in Hippocratic oath was included to be for legal, economic and social reasons at the time. That the clause is found mostly in the ancient-medieval oaths can be attributed to the influence of the original. This commitment is generalised and associated with others by contemporary formulas. Currently, sexual relationships are the subject of legal and ethical analysis and their inclusion in the oaths is being debated.

Discriminación en la atención médica: una mirada a través de los juramentos médicos / Discrimination in medical assistance: An overview based on medical oath

BACKGROUND: All humans have the right to receive a thorough medical attention, and should not be discriminated. AIMS: To determine if there is a significant relationship between Medical Oaths that commit to the principle of no discrimination in health care and the time, origin and source of the modifications to the Hippocratic Oath. To specify which are the conditions for no discrimination. MATERIALS AND METHODS: Fifty Oaths found in different articles and publications were analyzed and selected considering their historical context. RESULTS: Of the fifty Oaths that were analyzed, nineteen express a commitment towards no discrimination, whereas one of the texts is discriminatory. The only significant relationship found was the origin and source of the texts. The most frequently discriminating factors found are social class, religion, nationality and race. At present, other factors can be found such as ideology, moral, aptitude, sex and political and sexual preferences. CONCLUSIONS: The commitment towards no discrimination is not widely found in Medical Oaths of all times (30/50). According to the bioethics principle of justice, physicians should find the limit of their obligation as doctors in providing medical assistance to everyone alike, wealthy or poor; Christians, Hebrews or Muslims; men or women; children, adults or old; with or without infectious diseases. Non discrimination should be a vow that physicians must be willing to take despite any of the factors that could influence health care.

[Confidentiality in medical oaths: (When the white crow becomes gray...)]. / Confidencialidad en los juramentos médicos (cuando el cuervo blanco se vuelve gris...).

Confidentiality, together with the ethical principles of beneficence and non-maleficence, is the most important rule in Medical Oaths at the present time. However, the scientific-technical advances in medicine have made this rule one of the most controversial ones because of its exceptions. In consequence, the aim of the present paper is to comparatively analyze the rule of confidentiality in Medical Oaths of different places, times, origins and in different versions of the Hippocratic Oath in order to determine what should be kept a secret and with what degree of commitment (absolute or "prima facie"). Of the thirty six analyzed Oaths, twenty-seven manifest this rule and nine do not. No relation was found between the manifestation of this rule and the place, time, origin and different versions of the Hippocratic Oath. Most pledges suggest not to reveal what has been seen or heard during the medical act, the same as in the Hippocratic Oath. Seven texts point out that confidentiality should be absolute and four give exceptions in connection with beneficence and justice principles and the moral duty of causing no damage to third parties. Two pledges specify protection of privacy. In conclusion, today confidentiality is considered to be a moral duty for the benefit of the patient and out of consideration for his autonomy; however, at the present time in medicine the duty of keeping absolute secrecy is being reconsidered.

Confidencialidad en los juramentos médicos (cuando el cuervo blanco se vuelve gris...). / [Confidentiality in medical oaths: (When the white crow becomes gray...)]

Confidentiality, together with the ethical principles of beneficence and non-maleficence, is the most important rule in Medical Oaths at the present time. However, the scientific-technical advances in medicine have made this rule one of the most controversial ones because of its exceptions. In consequence, the aim of the present paper is to comparatively analyze the rule of confidentiality in Medical Oaths of different places, times, origins and in different versions of the Hippocratic Oath in order to determine what should be kept a secret and with what degree of commitment (absolute or [quot ]prima facie[quot ]). Of the thirty six analyzed Oaths, twenty-seven manifest this rule and nine do not. No relation was found between the manifestation of this rule and the place, time, origin and different versions of the Hippocratic Oath. Most pledges suggest not to reveal what has been seen or heard during the medical act, the same as in the Hippocratic Oath. Seven texts point out that confidentiality should be absolute and four give exceptions in connection with beneficence and justice principles and the moral duty of causing no damage to third parties. Two pledges specify protection of privacy. In conclusion, today confidentiality is considered to be a moral duty for the benefit of the patient and out of consideration for his autonomy; however, at the present time in medicine the duty of keeping absolute secrecy is being reconsidered.

[Analysis of the ethical principles of beneficence and no harm in medical oaths in relation with the Hippocratic one]. / Análisis de los principios éticos de beneficencia y de no-maleficencia en los juramentos médicos, en relación con el hipocrático.

The principles of beneficence and no-maleficence, already set forth in the Hippocratic Oath, have been the foundation of medical ethics for the last twenty-five centuries. The principle of beneficence is currently maintained in most wordings of the pledges of medical schools of the United States, Canada and Argentina; it is not the same with the principle of non-maleficence. The aim of this paper is to determine whether these principles are described in medical oaths at different times. These principles did not remain in an oaths. Of twenty-nine analyzed texts, nine describe both principles simultaneously, eleven only mention beneficence; three only express non-maleficence, and six indicate neither of them. Most wordings that describe these principles are modifications of the Hippocratic Oath. Two contemporary wordings describe the achievement of the greatest benefit with minimum harm. Two current wording also subordinate the principle of beneficence to the principle of respect for the patient's autonomy, and eight wordings indicate not only patients' benefit in particular but that of society in general. It is not possible to ignore that it is no enough to fulfill only these two principles. Physicians should encourage the development of patients' responsibility in managing their own health and respect their autonomy.

[Analysis of the ethical principles in medical oaths used by medical schools of Argentina in relation to the Hippocratic Oath]. / Análisis de los principios eticos en juramentos médicos utilizados en las Facultades de Medicina de la Argentina en relación al Hipocratico.

Medical oaths have consulted the source of all Medical Ethics through centuries. Since the 60s a new consensus on ethics was sought to apply to the new medical problems. The consensus was on the basic principles: beneficence, non-maleficence, justice and respect for the patient's autonomy with its two rules of confidentiality and veracity. The Hippocratic Oath specifies the principles of beneficence and non-maleficence and the rule of confidentiality. They are included in the texts used in different Medical Schools of the United States, Canada and the United Kingdom. The purpose of this analysis is to determine which of those ethical principles are included in the Argentinian Medical Oaths. At present, out of the ten Faculties of Medicine that use a formula, six choose the Declaration of Geneva and the rest use their own texts. No schools use the Hippocratic Oath. Neither of the five different Oaths include the four principles. The rule of confidentiality is the one most frequently mentioned followed by the principles of beneficence and justice. The principles of non-maleficence and of respect for the patient's autonomy, in general, and the rule of veracity, in particular, are not indicated. Revision of the Medical Oaths used in Argentina, is basically for the ethical revision suggested, in order to include all the ethical principles strongly agreed upon.

[A teaching-learning experience: changes in beliefs and behaviors in the management of drinking water]. / Experiencia de enseñanza-aprendizaje: cambio de creencias y conductas en el manejo del agua de consumo.

It was studied a change in the children's beliefs and behaviour with regard to their handling of drinking-water by using a teaching-learning experience by means of microscopic observation of polluted water. A structured pre-test on problem-solving were administered to 63 6th and 7th grade elementary school children (28 boys and 35 girls). An of these children came from an underprivileged population in the north of Buenos Aires, Argentina. Their average age was of 12 years 8 months and SD = 1 year 1 month. Each adequate aspect of their behaviour scored one point: hygiene and protection of containers for collection and storage, water treatment (boiling or the addition of chlorine) and the conservation period. The best beliefs ("to avoid the water contamination that produces illness") scored two points. The number of pupils that changed their beliefs and and behaviour in the post-test was established and the significant difference was found by means of Chi square test (X2). The children did not, in general, improve their behaviour or beliefs. They maintained adequate hygienic behaviour, but did not put into practice the protection of the containers used for the collection. Behaviour regarding storage was still inadequate. The pupils did acquire correct behaviour as regards storage was still inadequate. The pupils did acquire correct behaviour as regards treatment by the boiling of water or the addition of chlorine (P less than 0.01). However, the beliefs involved did not change.(ABSTRACT TRUNCATED AT 250 WORDS)

[Drinking water and garbage: customs and beliefs among schoolchildren of a marginal population]. / Agua de consumo y basuras: costumbres y creencias en escolares de una población marginal.

A study of 80 children from 6th and 7th grades was conducted to determine their beliefs and behaviours about drinking-water and garbage management. The children come, in their totality, from a poor suburban population of the north of Buenos Aires. The survey showed that most of the children kept some drinking-water provision at home. Therefore, they had to collect, treat, and store the water. The pupils had correct knowledge about the process of contamination and some adequate behaviours concerning the hygiene of collection containers, but also showed inadequate conceptions about the protection of such containers and water treatment. The children reported inadequate behaviours and incorrect beliefs about the elimination of garbage. These results establish the need for teaching-learning experiences designed to reinforce correct knowledge and behaviours and modify the incorrect ones.