Multidimensional Study of the Attitude towards Euthanasia of Older Adults with Mixed Anxiety-Depressive Disorder.

INTRODUCTION: This study aims to verify if older adults with mixed anxiety-depressive disorder are more prone to euthanasia and identify factors that interfere with their satisfaction with health and capacity for well-informed decisions. MATERIAL AND METHODS: The study applied a paper questionnaire composed of a sociodemographic section and a battery of scales (to assess depression, anxiety, cognitive performance, suicide risk, therapeutic adhesion, functionality, loneliness, attitude towards euthanasia, decision pattern, personality, empathy, and health status) in the Psychogeriatric Unity of Senhora da Oliveira Hospital in Portugal. The sample was collected by convenience to include patients and controls of the same age. Six months later, a reassessment was performed. Patients and controls were compared using descriptive statistics and a multiple-regression model. RESULTS: A total of 114 patients and 25 controls were included. Eighty-one point six percent of patients had four or fewer years of schooling. Contrary to controls, they presented mild depressive and anxiety symptoms, loneliness feelings, worse cognitive performance, a more fragile personality, higher personal distress, and a poorer health state. No statistically significant differences were found between controls and patients regarding their attitudes towards euthanasia. Patients more favourable to euthanasia had higher empathic concern, conscientiousness, and fantasy, and lower personal distress. DISCUSSION AND CONCLUSION: When addressing euthanasia in these patients, it is crucial to ensure they are fully self-determinate and that all the necessary treatment and support are available. It may not be the case when the educational level is low and a mild disease persists, significantly affecting their well-being and cognitive performance.

Cross-Cultural Adaptation and Validation of an Attitude about Euthanasia Scale in Portuguese Older Adults with Mixed Anxiety-Depressive Disorder.

On 25 May 2023, the Portuguese parliament approved the decriminalisation of euthanasia for incurable illnesses. As the experiences of other countries show us, it will be a matter of time before mental disorders are addressed. Studying the phenomenon, particularly in vulnerable groups, in advance is essential for proper law drafting. Therefore, instruments that allow an objective assessment and comparison between groups must be available. This study aims to explore the validation of Faria's attitude about euthanasia scale in Portuguese older adults with mixed anxiety-depressive disorder. A sample of 114 older adults with mixed anxiety-depressive disorder collected by convenience in the Psychiatry Department of Senhora da Oliveira Hospital in Portugal was included. The pre-final version of the scale was tested in a small group with good results. The validity of the internal structure was analysed using exploratory factorial analysis. The internal consistency study verified reliability. For construct validity, we assessed the correlation with other validated scales measuring attitudes toward euthanasia, cognitive performance, personality and empathy. The attitude about euthanasia scale showed good internal consistency. One factor was retained in the principal component analysis. Significant correlations verified construct validity. The results support the scale's usefulness and validity. This study makes available a unique instrument to assess the overall tendency of the attitudes towards euthanasia from the European-Portuguese perspective, which can be used, for example, to compare Portuguese with Brazilian older adults suffering from the same disorder. Furthermore, the adapted scale paves the way for other cross-cultural translations, adaptations, validations, and comparative analyses.

Efficiency, planning and good management, determining factors for a greater equity on health care expenses: the experience from the program family health strategy in Brazil

The present work presents as a research problem the importance of efficiency, planning, and principles of good management aiming at capillarity and equity to generate greater access and quality of services. The objective of this article was to identify the expansion of the Family Health Strategy in Brazil between 2007 and 2020, and which variables may explain this evolution. This is a descriptive, ecological research, developed between 2007 and 2020 in Brazil; its variable of interest was the estimated population coverage of this strategy (%). An increase in the coverage of the Family Health Strategy was observed in all regions of Brazil between 2007 and 2020, especially in the Northeast region. At the state level, this coverage showed a significant positive relationship with the following variables: towns with fewer than 40,000 inhabitants and monthly income inferior to half a minimum salary. The Brazilian version of the Family Health Strategy seeks inspiration from the best and most successful health models to achieve high performance and efficiency to provide equity and access to health services.

El presente trabajo aborda como problema de investigación la importancia de la eficiencia, la planificación y los principios de buena gestión que apuntan a la capilaridad y la equidad para generar un mayor acceso y calidad de los servicios. El objetivo de este artículo fue identificar la expansión de la Estrategia Salud de la Familia en Brasil entre 2007 y 2020 y las variables que pueden explicar esta evolución. Se trata de una investigación descriptiva y ecológica, desarrollada entre 2007 y 2020 en Brasil; su variable de interés fue la cobertura demográfica estimada de esta estrategia (%). Se observó un aumento de la cobertura de la Estrategia Salud de la Familia en todas las regiones de Brasil entre 2007 y 2020, especialmente en la región noreste. A nivel estatal, esta cobertura mostró una relación positiva significativa con las siguientes variables: municipios con menos de 40.000 habitantes e ingresos mensuales inferiores a medio salario mínimo. La versión brasileña de la Estrategia de Salud de la Familia busca su inspiración en los mejores y más exitosos modelos de salud para alcanzar un alto rendimiento y eficiencia para proporcionar equidad y acceso a los servicios de salud.

O presente trabalho apresenta como um problema de pesquisa a importância da eficiência, planejamento e princípios de boa gestão objetivando capilaridade e eqüidade para gerar maior acesso e qualidade dos serviços. O objetivo desse artigo foi identificar a expansão da Estratégia de Saúde da Família no Brasil entre 2007e 2020 e quais variáveis podem explicar essa evolução. Esse é uma pesquisa descritiva, ecológica, desenvolvida entre 2007 e 2020 no Brasil: sua variável de interesse foi a cobertura estimada da população dessa estratégia (%). Um aumento na cobertura da Estratégia de Saúde da Família foi observada em todas as regiões do Brasil entre 2007 e 2020, especialmente na região Nordeste. A nível estadual, essa cobertura mostrou uma relação significante positiva com as seguintes variáveis: cidades com menos de 40.000 habitantes e renda mensal inferior a metade do salário mínimo. A versão brasileira da Estratégia de Saúde da Família busca inspiração nos melhores e mais bem sucedidos modelos de saúde para alcançar alto desempenho e eficiência no fornecimento de eqüidade e acesso a serviços de saúde.

Distributive justice and equity in resource allocation: a temporal analysis of hospitalization costs in indigenous populations in Brazil.

INTRODUCTION: In Brazil, a country of continental dimensions, the health needs of each region have an impact. In this context and the name of the principle of equity, the SUS organizes actions especially aimed at social groups such as the elderly, children, pregnant women, and indigenous peoples. The concept of justice proposed by John Rawls is one of equity, which is essential to this country. METHODS: This is an ecological, descriptive study, which analyzed hospital spending on cardiovascular diseases in the Unified Health System (SUS) among the indigenous elderly population and other ethnicities/colors in Brazil, between 2010 and 2019. RESULTS: Hospitalization costs and fatality rates for indigenous populations and other colors/ethnicities, between 2010 and 2019, were evaluated. A reduction in hospitalization costs for the indigenous population and an increase in other populations was observed throughout the historical series, while there was an increase in fatality rates for both groups. A comparison was made between hospitalization costs and the fatality rates of indigenous populations and other colors/ethnicities according to sex, between 2010 and 2019. It was observed that regardless of sex, there are significant differences (p<0.05) between hospitalization costs and fatality rates, with higher costs for patients of other colors/ethnicities and higher fatality rates for the indigenous population. CONCLUSIONS: Hospitalization costs due to cardiovascular diseases in elderly people from indigenous populations were lower compared to other ethnicities in most federative units, which may suggest an unequal allocation of resources or access for this indigenous population to the SUS. Although there is no strong correlation between spending on hospital admissions and fatality rates, it was found that these rates increased between 2010 and 2019, while spending was reduced.

Communication strategies used by medical physicians when delivering bad news at the Maputo Central Hospital, Mozambique: a cross-sectional study.

BACKGROUND: Physicians' communication with patients and their families is important during both the disease diagnosis and prognosis stages and through the follow-up process. Effective physician communication improves patients' quality of life and satisfaction with care and helps reduce suffering for those newly diagnosed with advanced progressive illnesses. This study aims to identify the communication strategies physicians use in the transition to palliative care and how these professionals perceive their academic and clinical preparation concerning this task. METHODS: A cross-sectional and quantitative study. Physicians providing palliative care at the Maputo Central Hospital, Mozambique, were invited to complete a 17-question questionnaire. This questionnaire was based on a Brazilian adaptation of the Setting-Perception-Invitation-Knowledge-Emotions-Strategy (SPIKES) tool, the P-A-C-I-E-N-T-E protocol, with additional questions regarding socio-demographic details and the integration of "communication of bad news" into hospital training. RESULTS: Of the 121 participants, 62 (51.2%) were male, and 110 (90.9%) were general practitioners, with a median age of 36 years old. They had worked in clinical practice for a median of 8 years and in their current department for three years. The majority of the participants considered that they have an acceptable or good level of bad news communication skills and believed that they do it in a clear and empathic way, paying attention to the patient's requests and doubts; however, most were not aware of the existing tools to assist them in this task and suggested that delivering bad news ought to be integrated into the undergraduate medical course and included in hospital training. CONCLUSIONS: This study adds to our understanding of physicians' strategies when communicating bad news in the context of palliative care at one Mozambique hospital. As palliative care is not fully implemented in Mozambique, it is important to use protocols suitable to the country's healthcare level to improve how doctors deal with patients and their family members.

Equity in health and justice: a look at the Brazilian unified health system (SUS) from the perspective of John Rawls

This study addresses the issue of equity in health and justice from the perspective of public health bioethics, describing the Brazilian Unified Health System (SUS), equating legitimate interests for essential goods, such as health. The conception of John Rawls' theory of justice is "justice as fairness" and has a seventeenth century contractualism tenor. Although it was not conceived specifically for health and marked by the "difference principle", it promoted, in the field of health care, the institution of health systems created on the basis of universal access and equity in the distribution of scarce resources. The principles of the Brazilian Unified Health System (SUS) guarantee access to all levels of care, equality in health care, without distinctions or privileges of any kind, integrity in health care, free of charge, community participation and decentralization, regionalization and hierarchization of health actions and services, which gives the SUS a strong Rawlsian bias. The Brazilian model was built on the principle that health is a right of all and a duty of the State, therefore, it is based on the assumption of universal and equal access to health actions and services for its promotion and recovery.

Este estudio aborda el tema equidad en salud y justicia desde la perspectiva de la bioética de la salud pública, describiendo el Sistema Único de Salud (SUS) brasileño, equiparando intereses legítimos por los bienes esenciales, como la salud. La concepción de la teoría de justicia de John Rawls es la "justicia como equidad" y tiene un tenor de contractualismo del siglo XVII. Aunque no fue concebida específicamente para la salud y marcada por el "principio de la diferencia", impulsó, en el ámbito de la atención sanitaria, la institución de sistemas de salud creados sobre la base del acceso universal y la equidad en la distribución de recursos escasos. Los principios del Sistema Único de Salud (SUS) brasileño garantizan el acceso para todos los niveles asistenciales, igualdad en la atención a la salud, sin distinciones ni privilegios de ningún tipo, integridad en la asistencia a la salud, gratuidad, participación comunitaria y una descentralización, regionalización y jerarquización de las acciones y servicios de salud, lo que da al SUS un fuerte sesgo rawlsiano. El modelo brasileño se construyó sobre el principio de que la salud es un derecho de todos y un deber del Estado, por lo tanto, se basa en el supuesto del acceso universal e igualitario a las acciones y servicios de salud para su promoción y recuperación.

Este estudo aborda a questão da equidade em saúde e da justiça sob a perspectiva da bioética da saúde pública, descrevendo o Sistema Único de Saúde (SUS), equiparando interesses legítimos para bens essenciais, como a saúde. A concepção da teoria da justiça de John Rawls é "justiça como equidade" e tem um teor contratualista do século XVII. Embora não tenha sido concebida especificamente para a saúde e marcada pelo "princípio da diferença", ela promoveu, no campo da assistência à saúde, a instituição de sistemas de saúde criados com base no acesso universal e na equidade na distribuição de recursos escassos. Os princípios do Sistema Único de Saúde (SUS) garantem o acesso a todos os níveis de atenção, a igualdade na assistência à saúde, sem distinções ou privilégios de qualquer espécie, a integralidade na assistência à saúde, a gratuidade, a participação da comunidade e a descentralização, regionalização e hierarquização das ações e serviços de saúde, o que confere ao SUS um forte viés rawlsiano. O modelo brasileiro foi construído com base no princípio de que a saúde é um direito de todos e um dever do Estado, portanto, parte do pressuposto do acesso universal e igualitário às ações e serviços de saúde para sua promoção e recuperação.

Complaints against Physicians in Minas Gerais, Brazil / Quejas contra médicos en Minas Gerais, Brasil / Reclamações contra médicos em Minas Gerais, Brasil

The Regional Councils of Medicine are responsible for the first instance evaluation of ethical-professional complaints against physicians in each federation state. The relevance of the study is based on the importance of evaluating the professional profile of the reported physician, the characteristics of the complaints, and the judging body performance. This study assessed 966 complaints against physicians made to the Regional Council of Medicine of Minas Gerais (CRM/MG) from 2012 to 2017. There was no difference in the average age of the professionals or the period of professional practice. Gynecology, Internal Medicine, General Surgery, and Plastic Surgery comprised most of the complaints regarding medical specialties. The non-specialty reports reached 323 (34%) cases and predominated over the years studied. The number of acquittals was relatively high, in a total of 535 cases, in which the Regional Council of Medicine of Minas Gerais (CRM/MG) considered the complaints unfounded. The hypothesis of a certain corporativism of the CRM did not seem viable since thirty cases received harsher punishments, and among them, eight were removed from professional practice. Some professionals were reported more than once. It is worth noting that the number of recidivists and cases progressively decreased from 2012 to 2017.

Los Consejos Regionales de Medicina son responsables de la evaluación en primera instancia de las denuncias ético-profesionales contra médicos en cada estado de la federación. La relevancia del estudio se basa en la importancia de evaluar el perfil profesional del médico denunciado, las características de las denuncias y la actuación del órgano juzgador. Este estudio evaluó 966 denuncias contra médicos presentadas al Consejo Regional de Medicina de Minas Gerais (CRM/MG) de 2012 a 2017. No hubo diferencias en la edad media de los profesionales ni en el período de ejercicio profesional. Ginecología, Medicina Interna, Cirugía General y Cirugía Plástica englobaron la mayoría de las denuncias relativas a especialidades médicas. Las denuncias de no especialidad alcanzaron 323 (34%) casos y predominaron a lo largo de los años estudiados. El número de absoluciones fue relativamente elevado, en un total de 535 casos, en los que el Consejo Regional de Medicina de Minas Gerais (CRM/MG) consideró infundadas las denuncias. La hipótesis de un cierto corporativismo del CRM no pareció viable, ya que treinta casos recibieron castigos más severos y, entre ellos, ocho fueron apartados del ejercicio profesional. Algunos profesionales fueron denunciados más de una vez. Cabe destacar que el número de reincidentes y de casos disminuyó progresivamente de 2012 a 2017.

Os Conselhos Regionais de Medicina são responsáveis pelas avaliações, em primeira instância, de denúncias ético-profissionais contra médicos, em cada estado da federação. A relevância do presente estudo se fundamenta na importância de se avaliar o perfil profissional do denunciado, as características das denúncias e o desempenho do órgão julgador. O presente estudo avaliou 966 denúncias contra médicos, feitas ao Conselho Regional de Medicina de Minas Gerais (CRM/MG), de 2012 a 2017. Não houve diferença com relação à média de idade do profissional, nem com relação ao tempo de exercício profissional. No que diz respeito às especialidades médicas (tabela 5), as áreas de Ginecologia, Clínica Médica, Cirurgia Geral e Cirurgia Plástica compreenderam grande parte das denúncias. Os denunciados sem especialidade alcançaram o no número de 323 (34%) e predominaram. O número de absolvições foi relativamente alto, num total de 535 denunciados, nos quais o Conselho Regional de Medicina de Minas Gerais (CRM/MG) considerou as acusações infundadas. A hipótese de certo corporativismo do CRM, não pareceu viável, visto que trinta casos receberam punição mais severa, dentre os quais, oito cassações do exercício profissional. Alguns profissionais foram denunciados mais de uma vez. Vale observar que o número de profissionais reincidentes, bem como o número de processos decaiu progressivamente, de 2012 a 2017.

Burnout among Physicians Working in Palliative Care During the COVID-19 Pandemic in Portugal: A Cross-Sectional Study.

INTRODUCTION: Physicians working in palliative care have a greater risk of burnout. Burnout has three dimensions: emotional exhaustion, depersonalization and reduction of personal accomplishments. Burnout is associated with different consequences for the professionals like less professional satisfaction and increase of overall levels of exhaustion. Burnout in healthcare professionals has an impact in the patients with increased probability of clinical erros. In order to monitor the quality of the care it is mandatory to assess overall levels of burnout. This study aimed to determine burnout levels and associated variables of physicians working in the Portuguese national network of palliative care. MATERIAL AND METHODS: A cross-sectional, exploratory and quantitative design was employed and participants were sampled using convenience and snowball technique. The Copenhagen Burnout Inventory was used to determine burnout levels of physicians working in the Portuguese National Network of Palliative Care. The contributions of personal, work and COVID-19 variables were evaluated in three subclasses: work, personal and patient-related burnout. The results obtained enabled the identification of healthcare professionals at risk, comparison with previous results published and to assess the impact of COVID-19 in their non COVID-19 activity. RESULTS: Seventy-five physicians participated. Socio-demographic characterization was conducted and the levels of burnout and determinants were explored. High levels of personal, work and patient-related burnout were present in 32 (43%), 39 (52%) and 16 (21%) physicians, respectively. The majority agreed that COVID-19 had an impact on their activities. Exclusive dedication to palliative care and type of palliative care unit were associated with lower levels of patient and work-related burnout. Weekly physical activity was associated with lower levels of work and personal burnout. Self-perceived health status was associated with lower levels of burnout for all subclasses. CONCLUSION: There was a high level of burnout among physicians working in the Portuguese National Network of Palliative Care. Measures to identify and prevent burnout are necessary in order to protect these professionals.

Introdução: Os médicos que trabalham em cuidados paliativos apresentam um risco mais elevado de burnout. Esta perturbação psicológica carateriza-se por três dimensões ­ exaustão emocional, despersonalização e redução da realização pessoal ­ e está associada a diversas consequências para os profissionais como a diminuição da satisfação profissional ou o aumento dos níveis de exaustão. Ao afetar os profissionais de saúde, o burnout tem também impacto nos utentes, visto causar um aumento da probabilidade de erros clínicos. Com vista a monitorizar a qualidade dos cuidados prestados é fundamental monitorizar os níveis de burnout. O objetivo deste estudo foi o de determinar os níveis de burnout e varíaveis associadas dos médicos que trabalham na Rede Nacional de Cuidados Paliativos em Portugal. Material e Métodos: Estudo transversal, exploratório e quantitativo com amostragem por conveniência e bola de neve. Foi utilizado o questionário Copenhagen Burnout Inventory para determinar os níveis de burnout de médicos que exercem funções na Rede Nacional de Cuidados Paliativos. As contribuições das varíaveis pessoais, laborais e decorrentes da pandemia de COVID-19 foram analisadas segundo três subclasses: burnout pessoal, burnout relacionado com a atividade profissional e burnout relacionado com o utente. Os resultados obtidos permitiram identificar profissionais em risco, fazer uma comparação com resultados prévios na literatura e determinar o impacto da COVID-19 na atividade assistencial não relacionada com COVID-19. Resultados: Setenta e cinco médicos participaram neste estudo. Foi realizada a caraterização socio-demográfica e determinados os níveis de burnout e variáveis associadas. Níveis elevados de burnout pessoal, relacionados com a atividade profissional e para com o utente estavam presentes, respetivamente, em 32 (43%), 39 (52%) e 16 (21%) dos participantes. A maioria considerou que a COVID-19 teve um impacto na sua atividade clínica. A dedicação exclusiva em cuidados paliativos e o tipo de unidade de cuidados paliativos estavam associados a menor nível de burnout relacionado com atividade profissional e para com o utente. A autopercepção de saúde estava associada a menores níveis de burnout em todas as subclasses. Conclusão: Foi observado um elevado nível de burnout nos médicos que trabalham na Rede Nacional de Cuidados Paliativos. São necessárias medidas para identificar e prevenir o burnout nestes profissionais,com vista à sua proteção.

Ethnic-Regional Differences in the Allocation of High Complexity Spending in Brazil: Time Analysis 2010-2019.

The following paper presents as a research problem the ethnic-regional differences in the allocation of high complexity spending in Brazil in an analysis from 2010 to 2019. This is a descriptive research in which a generalized linear model (GLM) was developed to analyze these hospital expenditures with high complexity procedures. The total spending on high complexity procedures in Brazil has increased over the past decade. The study shows that the lowest average expenditures are found in the North and Northeast regions. When comparing the spending between different ethnicities, it was observed that the only decrease between the years 2010 and 2019 was in the amount spent on procedures in indigenous people. The spending on male patients was significantly higher compared to female patients. The highest expenditures, on the other hand, are concentrated in the regions of state capitals favoring the strengthening of hub municipalities. Geographic inequalities in access still persist, even with most states already offering almost all procedures. The Brazilian territory is very heterogeneous and needs to organize its health system by regions, therefore integrated public policies and economic and social development are urgently needed.

Nursing Home Residents Hospitalization at the End of Life: Experience and Predictors in Portuguese Nursing Homes.

(1) Background: Nursing Home (NH) residents are a population with health and social vulnerabilities, for whom emergency department visits or hospitalization near the end of life can be considered a marker of healthcare aggressiveness. With the present study, we intend to identify and characterize acute care transitions in the last year of life in Portuguese NH residents, to characterize care integration between the different care levels, and identify predictors of death at hospital and potentially burdensome transitions; (2) Methods: a retrospective after-death study was performed, covering 18 months prior to the emergence of the COVID-19 pandemic, in a nationwide sample of Portuguese NH with 614 residents; (3) Results: 176 deceased patients were included. More than half of NH residents died at hospital. One-third experienced a potentially burdensome care transition in the last 3 days of life, and 48.3% in the last 90 days. Younger age and higher technical staff support were associated with death at hospital and a higher likelihood of burdensome transitions in the last year of life, and Palliative Care team support with less. Advanced Care planning was almost absent; (4) Conclusions: The studied population was frail and old without advance directives in place, and subject to frequent hospitalization and potentially burdensome transitions near the end of life. Unlike other studies, staff provisioning did not improve the outcomes. The results may be related to a low social and professional awareness of Palliative Care and warrant further study.

Communication of the Diagnosis of Spinal Muscular Atrophy in the Views of Patients and Family Members, a Qualitative Analysis.

INTRODUCTION: Communicating the diagnosis of a genetic and neurodegenerative disease, such as spinal muscular atrophy (SMA), requires a transmission centered on the patient and/or the family caregiver, ensuring autonomy to those involved and strengthening the doctor-patient relationship. OBJECTIVE: Analyzing the communication of the SMA diagnosis from the perspective of patients and family members. METHODS: This qualitative study was developed through semi-structured interviews, via teleconsultation. The analysis was developed by systematically condensing the answers and synthesizing them into four thematic axes (clarification of the diagnosis, communication of the prognosis, affective memory related to the event, and advice to physicians). RESULTS AND DISCUSSION: Twenty-nine patients with SMA and 28 family caregivers of people with this condition, from all regions of Brazil, reported that individualized, clear, honest, and welcoming communication, emphasizing positive aspects, in the presence of family members and with the possibility of continuous monitoring, was important to meeting their communication needs. A lack of empathy, monitoring and guidance, and estimating life expectancy resulted in negative experiences. CONCLUSIONS: The communication needs of patients and family members described during the clarification of the diagnosis and prognosis of SMA predominantly involve empathic factors related to the attitude of the attending physician throughout the evolution of the disease. Future research evaluating other neurodegenerative diseases and the development of research protocols are important to improving communication between physicians, patients, and family members.

Performance of the professional councils concerning 966 complaints addressed to regional councils of medicine (CRM) of Minas Gerais, from 2012 to 2017 / Actuación de los consejos profesionales en relación con 966 quejas dirigidas a los Consejos Regionales de Medicina (CRM) de Minas Gerais, de 2012 a 2017 / Atuação dos conselhos profissionais em relação a 966 denúncias dirigidas ao CRM/MG, no período de 2012 a 2017

Abstract: The study aimed to analyze the actions of the Professional Councils in relation to 966 professional-ethical complaints addressed to the Regional Council of Medicine of Minas Gerais between 2012 and 2017. The number of cases, gender, articles violated of the Code of Medical Ethics and decisions made in the lawsuits were considered. An expressive result was observed in terms of acquittal (535 cases) by the Regional Council of Medicine of Minas Gerais. There was a divergence when the same cases were evaluated by the Federal Council of Medicine, which upheld the acquittal in only 29% of the cases. Due to the methodology applied, it was not possible to go beyond speculation on the subject, being necessary a better analysis of the scientific community on this issue.

Resumen: El estudio tuvo como objetivo analizar las acciones de los Consejos Profesionales en relación con 966 quejas ético-profesionales dirigidas al Consejo Regional de Medicina de Minas Gerais entre 2012 y 2017. Se consideró el número de casos, el género, los artículos violados del Código de Ética Médica y las decisiones tomadas en los juicios. Se observó un resultado expresivo en cuanto a la absolución (535 casos) por parte del Consejo Regional de Medicina de Minas Gerais. Hubo una divergencia cuando los mismos casos fueron evaluados por el Consejo Federal de Medicina, que mantuvo la absolución sólo en el 29% de los casos. Debido a la metodología aplicada, no fue posible ir más allá de la especulación sobre el tema, siendo necesario un mejor análisis de la comunidad científica sobre esta cuestión.

Resumo: O estudo visava analisar as acções dos Conselhos Profissionais em relação a 966 queixas de ética profissional dirigidas ao Conselho Regional de Medicina de Minas Gerais entre 2012 e 2017. Considerou o número de casos, género, artigos violados do Código de Ética Médica e as decisões tomadas nos julgamentos. Um resultado expressivo foi observado em termos de absolvição (535 casos) pelo Conselho Regional de Medicina de Minas Gerais. Houve uma divergência quando os mesmos casos foram avaliados pelo Conselho Federal de Medicina, que manteve a absolvição em apenas 29% dos casos. Devido à metodologia aplicada, não foi possível ir além da especulação sobre o assunto, sendo necessária uma melhor análise da comunidade científica sobre esta questão.

Communicating the Spinal Muscular Atrophy diagnosis to children and the principle of autonomy.

INTRODUCTION: The trinomial relationship between physicians/children/guardians is essential in the process of communicating a disease and its prognosis. OBJECTIVE: Analyzing the exercise of autonomy by this trinomial relationship in communicating the diagnosis of spinal muscular atrophy (SMA).   METHODOLOGY: Caregivers of SMA patients answered a questionnaire containing a structured interview and the Event Impact Scale - Revised. RESULTS: The sample comprised 50 volunteers, 94% of whom were female caregivers. Psychological trauma was predominantly reported when caregivers communicated the diagnosis to children. 22% have a high risk of post-traumatic stress, relating the feeling of unpreparedness in communicating this to the child. CONCLUSIONS: It was identified that the failure in communication is the main factor for negative repercussions on the autonomy of children and their guardians, with self-reported psychological trauma, besides the high risk for post-traumatic stress syndrome.

EMPATIA: A Guide for Communicating the Diagnosis of Neuromuscular Diseases.

INTRODUCTION: Neuromuscular diseases comprise a heterogeneous group of genetic syndromes that lead to progressive muscle weakness, resulting in functional limitation. There is a gap in the literature regarding the communication of the diagnosis of such diseases, compromising the autonomy of patients and families, besides causing stress on the assistant physician. OBJECTIVES: Developing a guide to reduce communication barriers in the diagnosis of neuromuscular diseases. METHODOLOGY: Systematic review, after searching the descriptors ("Muscular Diseases" OR "Neuromuscular Diseases") AND ("Truth Disclosure" OR "Bad news communication" OR "Breaking bad News") in the Pubmed, Bireme, and Scopus websites, and these results were analyzed through narrative textual synthesis. RESULTS: 16 articles were submitted to the final analysis, giving rise to seven steps to support the communication process. These are Empathy, Message, Prognosis, Reception, Time, Individualization, and Autonomy. DISCUSSION AND CONCLUSION: The empathic transmission of the message and the prognosis must accommodate the feelings of the interlocutors with different information needs. In this way, communication planning optimizes the time and individualizes each context, respecting the autonomy of those involved. EMPATIA reflects the bioethical and interdisciplinary analysis of the literature and comes to fill the gap related to the communication of bad news in neuromuscular diseases.

Coping Strategies Used by Patients After Diagnosis Disclosure in the Transition to Palliative Care: A Cross-Sectional Study.

Objectives: The objectives of this study were to identify the coping strategies used by cancer and non-cancer patients with palliative needs, and to verify if there were differences in the coping strategies adopted between sociodemographic groups. Methods: This is a cross-sectional study carried out from September to November 2019, at Maputo Central Hospital, in the units of Medicine, Surgery, Orthopedics, Gynecology and Obstetrics. Eligible patients (n = 94) were included in the study and answered a self-completion scale adapted from the Coping Strategies Inventory by Folkman and Lazarus together with a sociodemographic questionnaire. Results: Our study demonstrates that the most used coping strategies were Social Support, followed by Planful Problem Solving, Escape-Avoidance, and Positive Reappraisal strategies. In addition, significant differences were observed between religious beliefs, with Christians resorting more to coping strategies related to Social Support, Accepting Responsibility and Escape-Avoidance than Evangelicals, and between different levels of education, with greater resort to Social Support, Accepting Responsibility, Planful Problem Solving, and Positive Reappraisal in patients with high education. Conclusions: The results indicate that most of the respondents in this study used more adaptive coping strategies, such as Social Support and Positive Reappraisal, and less avoidant strategies, such as Distancing and Confrontation. There is a need to reinforce positive strategies from health professionals to increase satisfaction, autonomy, and promote patient's quality of life.

Advance Directives: Knowledge of the Topic Among Psychiatrists.

Objective: Advance directives are becoming increasingly important as health technologies evolve. We sought to assess psychiatrists' knowledge of advance directives, as this knowledge is fundamental to the implementation and drafting of these personal documents. Methods: A previously published questionnaire that evaluated the knowledge of medical professors was used. The sample, composed of psychiatrists from Rio de Janeiro, Brazil, originated from a publicly available list. During the search process, the COVID-19 pandemic affected Brazil and the rest of the world, which influenced our methodology and results. Results: A total of 40 psychiatrists participated in the study. The results obtained, although not significant, suggested that psychiatrists with an increased time of practice had more knowledge of advance directives. Nevertheless, less than half of the participants had knowledge about this topic. Conclusion: The number of psychiatrists surveyed indicates the need for further studies on the subject. The influence of the COVID-19 pandemic on this study led to findings such as a change in sensitivity when addressing the topic and greater difficulty in contacting professionals.

The right to be forgotten and COVID-19: privacy versus public interest / El derecho al olvido y el COVID-19: privacidad frente a interés público / O direito ao esquecimento e COVID-19: privacidade versus interesse público

Abstract: Recent studies highlight the importance of digital surveillance to gather individual health information due to the global pandemic caused by the new COVID-19 disease. This paper analyses its legal and ethical implications at the interface between the individual right to privacy and the collective interests of public health. We framed the discussion in law, deontology and utilitarianism. The lasted theories and human rights, especially privacy, are crucial in our argument. Health-derived dilemmas and efforts to solve them, especially by information technologies, bioethics and law, exist at these perspectives' interface. In particular, we analysed the intersection between autonomy, the right to privacy, and the so-called 'right to be forgotten' in the public health context. In other words, we studied the right to obtain from the controller the erasure of health data - a radical means of control over personal data established in Article 17 of the General Data Protection Regulation (GDPR). Given the lack of specifics regarding collection and re-use of such data under the broad scope of public health purposes, implied consent does not address the issue of proportionality. We highlight legal safeguards' insufficiency, suggesting applying the 'right to be forgotten' according to an ethical interpretation.

Resumen: Estudios recientes destacan la importancia de la vigilancia digital para recoger información sanitaria individual debido a la pandemia mundial causada por la nueva enfermedad COVID-19. Este artículo analiza sus implicaciones legales y éticas en la interfaz entre el derecho individual a la privacidad y los intereses colectivos de la salud pública. Enmarcamos la discusión en el derecho, la deontología y el utilitarismo. Estas últimas teorías y los derechos humanos, especialmente la privacidad, son cruciales en nuestro argumento. Los dilemas relacionados con la salud y los esfuerzos por resolverlos, especialmente a través de la tecnología de la información, la bioética y el derecho, se encuentran en la interfaz de estas perspectivas. En particular, analizamos la intersección entre la autonomía, el derecho a la privacidad y el llamado "derecho al olvido" en el contexto de la salud pública. Es decir, estudiamos el derecho a obtener del responsable del tratamiento la supresión de los datos de salud, un medio radical de control sobre los datos personales establecido en el artículo 17 del Reglamento general de protección de datos (RGPD). Dada la falta de especificidades en cuanto a la recogida y reutilización de dichos datos dentro del amplio ámbito de los objetivos de salud pública, el consentimiento implícito no aborda la cuestión de la proporcionalidad. Destacamos la insuficiencia de las garantías legales, sugiriendo la aplicación del "derecho al olvido" según una interpretación ética.

Resumo: Estudos recentes salientam a importância da vigilância digital para recolher informações individuais de saúde devido à pandemia global causada pela nova doença COVID-19. Este artigo analisa as suas implicações legais e éticas na interface entre o direito individual à privacidade e os interesses coletivos da saúde pública. Enquadramos a discussão no direito, na deontologia e no utilitarismo. As últimas teorias e os direitos humanos, especialmente a privacidade, são cruciais na nossa argumentação. Dilemas derivados da saúde e esforços para os resolver, especialmente através das tecnologias da informação, da bioética e do direito, existem na interface destas perspetivas. Em particular, analisámos a intersecção entre autonomia, direito à privacidade, e o chamado "direito ao esquecimento" no contexto da saúde pública. Por outras palavras, estudámos o direito de obter do responsável pelo tratamento o apagamento dos dados de saúde, um meio radical de controlo dos dados pessoais estabelecido no artigo 17º do Regulamento Geral de Proteção de Dados (RGPD). Dada a falta de especificidades em relação à recolha e reutilização de tais dados no âmbito alargado dos objetivos de saúde pública, o consentimento implícito não aborda a questão da proporcionalidade. Destacamos a insuficiência de salvaguardas jurídicas, sugerindo a aplicação do "direito ao esquecimento" de acordo com uma interpretação ética.

The right to be forgotten versus the right to disclosure of gamete donors' id: ethical and legal considerations / El derecho al olvido frente al derecho a revelar la identificación de los donantes de gametos: consideraciones éticas y jurídicas / O direito ao esquecimento versus o direito à divulgação da identificação de dadores de gâmetas: considerações éticas e legais

Abstract: 15. The anonymity of gamete donors in the context of medically-assisted reproduction techniques (ART) and the right of the offspring to know their genetic or biological parents' identity is a controversial and widely debated topic in the scientific literature. The positions on the issue in each country are different. Sometimes they are in opposition to each other even in countries with strong similarities, such as those in the European Union (EU), in the framework of shared ethical values. Although some countries still enshrine the rule of anonymity, there is an undeniable tendency to guarantee the right to know one's origins by creating relevant exceptions or abolishing donor anonymity status altogether. 16. This article offers ethical and legal considerations of whether the so-called 'right to be forgotten' (RTBF) could be extended to include gamete donors' right to remain anonymous. This perspective goes against the general trend, certainly in Europe, of recognizing that offspring born from donor gametes have a right to access information relating to their genetic progenitors. The novel addition is to question whether the General Data Protection Regulation (GDPR) might provide fertile ground for questioning this approach, and effectively support those jurisdictions where anonymity is still possible.

Resumen: 20. El anonimato de los donantes de gametos en el contexto de las técnicas de reproducción médicamente asistida (RM) y el derecho de la descendencia a conocer su identidad genética o biológica es un tema controvertido y ampliamente debatido en la literatura científica. Las posiciones sobre el tema en cada país son diferentes. A veces se oponen entre sí, incluso en países con fuertes similitudes, como los de la Unión Europea (UE), en el marco de valores éticos compartidos. Aunque algunos países siguen consagrando la norma del anonimato, es innegable la tendencia a garantizar el derecho a conocer el propio origen creando las excepciones pertinentes o suprimiendo por completo el estatus de anonimato del donante. 21. Este artículo ofrece consideraciones éticas y jurídicas sobre si el llamado "derecho al olvido" podría ampliarse para incluir el derecho de los donantes de gametos a permanecer en el anonimato. Esta opinión es contraria a la tendencia general, ciertamente en Europa, de reconocer que los hijos nacidos de gametos donados tienen derecho a acceder a la información relativa a sus padres genéticos. La nueva adición consiste en debatir si el Reglamento general de protección de datos (RGPD) podría proporcionar un terreno fértil para cuestionar este enfoque y apoyar efectivamente a las jurisdicciones en las que el anonimato sigue siendo posible.

Resumo 25. O anonimato dos dadores de gâmetas no contexto das técnicas de reprodução medicamente assistida (RMA) e o direito da descendência a conhecer a sua identidade genética ou biológica é um tema controverso e amplamente debatido na literatura científica. As posições sobre a questão em cada país são diferentes. Por vezes estão em oposição umas às outras, mesmo em países com fortes semelhanças, como os da União Europeia (UE), no quadro de valores éticos partilhados. Embora alguns países ainda consagrem a regra do anonimato, existe uma tendência inegável para garantir o direito de conhecer as suas origens, criando exceções relevantes ou abolindo completamente o estatuto de anonimato dos dadores. 26. Este artigo oferece considerações éticas e legais sobre se o chamado "direito ao esquecimento" poderia ser alargado para incluir o direito dos dadores de gâmetas a permanecerem anónimos. Esta perspetiva vai contra a tendência geral, certamente na Europa, de reconhecer que os descendentes nascidos de gâmetas doadas têm o direito de aceder à informação relacionada com os seus progenitores genéticos. O novo aditamento é debater se o Regulamento Geral de Proteção de Dados (RGPD) poderá fornecer um terreno fértil para questionar esta abordagem, e apoiar efetivamente as jurisdições onde o anonimato ainda é possível.

Gender Transition: Is There a Right to Be Forgotten?

The European Union (EU) faced high risks from personal data proliferation to individuals' privacy. Legislation has emerged that seeks to articulate all interests at stake, balancing the need for data flow from EU countries with protecting personal data: the General Data Protection Regulation. One of the mechanisms established by this new law to strengthen the individual's control over their data is the so-called "right to be forgotten", the right to obtain from the controller the erasure of records. In gender transition, this right represents a powerful form of control over personal data, especially health data that may reveal a gender with which they do not identify and reject. Therefore, it is pertinent to discern whether the right to have personal data deleted-in particular, health data-is ethically acceptable in gender transition. Towards addressing the ethical dimensions of the right to be forgotten in this case, this study presents relevant concepts, briefly outlines history, ethics and law of records considering the evolution from paper to electronic format, the main aspects of identity construction and gender identity, and explores the relationship between privacy, data protection/information control and identity projection. Also, it discusses in gender transition the relation between "the right to self-determination", "the right to delete", and "the right to identity and individuality". Conclusions on the ethical admissibility of the 'right to be forgotten' to control gender-affirming information are presented.