Medios de comunicación y eutanasia en Colombia. Análisis de contenido y categorización argumentativa / Mass media and euthanasia in Colombia. Content analysis and argumentative categorization

Resumen Introducción. La eutanasia fue despenalizada en Colombia mediante la Sentencia C-239/97 y reglamentada por la Resolución 1216 de 2015 del Ministerio de Salud y Protección Social. Se investigó en algunos medios de circulación nacional la posición a favor, neutra y en contra sobre la eutanasia y su carga argumentativa entre los años 1997 y 2015. Objetivos. Determinar la posición de algunos medios de comunicación frente a la eutanasia durante 1997-2015 y analizar su contenido argumentativo. Materiales y métodos. Tras una búsqueda en las versiones virtual e impresa de los periódicos El Tiempo y El Espectador y la Revista Semana, se realizó una clasificación y análisis de contenido de los artículos sobre la eutanasia con apoyo del programa ATLAS.ti, versión 8. Resultados. De 257 artículos recuperados, 190 incluyeron el término eutanasia en relación con el final de la vida y la salud. El 45% fueron neutros y de carácter informativo y el 78.9% no mencionó los cuidados paliativos. La carga argumentativa a favor recayó sobre contenidos de dignidad, sufrimiento y regulación. Conclusiones. Los artículos presentaron posiciones opuestas con errores de contenido y superficialidad en el tratamiento del concepto. La postura prevalente fue neutra seguida de la posición a favor. Se evidencia escasa participación de la comunidad médica y casi ninguna mención de los cuidados paliativos.

Abstract Introduction: Euthanasia was decriminalized in Colombia by means of Sentence C-239/97 and regulated through Resolution 1216 of2015 of the Ministry of Health and Social Protection. Some Colombian media were consulted to identify whether their position was in favor, neutral or against euthanasia and their reasons during the period 19972015. Objectives: To establish the position of some media regarding euthanasia during 1997-2015 and analyze their reasoning. Materials and methods: After conducting a search in the digital and printed versions of El Tiempo, El Espectador and Revista Semana, a classification and content analysis of the articles on euthanasia was carried out using the software ATLAS.ti, version 8. Results: From 257 articles retrieved, 190 included the term euthanasia in the context of health and end of life. 45% of the articles were neutral and informative and 78.9% did not mention palliative care. Favorable opinions were related to contents about dignity, suffering and regulation. Conclusions: The articles presented contrasting positions with content mistakes and superficial discussions on the issue. The prevailing position was neutral followed by favorable. There was little involvement of the medical community and almost no mention of palliative care.

[Family adherence in serious mental disorder]. / La adherencia familiar en el trastorno mental grave.

OBJECTIVE: Identify attitudes and behaviors that evidence and characterize family adherence to treatment in patients with severe mental disorder. DESIGN: Qualitative descriptive, from an interpretative social approach. LOCATION: Chia, Colombia, with professionals in the psychiatric and geriatric settings. PARTICIPANTS: Twelve professionals in psychiatry, nursing and psychology, with experience in care of patients with serious mental disorder and their families. METHOD: Intentional sampling. Twelve semi-structured interviews were carried out. The analysis strategy was made from the procedures of constant comparison and open coding of the grounded theory. As validation strategies, triangulation was done between researchers and methods, as interviews and results survey. RESULTS: Two categories of family adherence were defined: family and treatment (treatment cooperation, knowledge about the disease and attention to the disease evolution), and family attitudes towards the patient (patient's care, patient's promotion of autonomy, and affective attachment with the patient). A third category showed aspects that diminished family adherence, such as lack or distortion of information regarding mental disorder, or family and patient endurance attitudes. CONCLUSIONS: Participants agree about the relevance of the construct named «family adherence¼, which describes the behaviors and attitudes of the family regarding the treatment of patients with severe mental disorder. Family adherence can be seen as active participation behavior, but also as a process of strengthening relationships, which can reduce the burden and suffering on family members, caregivers and patients.

Percepciones de pacientes y familiares sobre la comunicación con los profesionales de la salud / Patients and relatives’ perception regarding communication with healthcare professionals

Objetivo Comprender las fortalezas y dificultades de la comunicación entre los profesionales y las familias con un miembro con enfermedad crónica o discapacidad, desde la percepción de pacientes y familiares que asisten a servicios sanitarios. Métodos Es un estudio cualitativo interpretativo. El enfoque psicológico es el sistémico, desde una perspectiva socio construccionista. La muestra fue contactada en la clínica de la Universidad de La Sabana, Colombia En la primera fase se diseñaron las preguntas guía con base en las categorías deductivas. En la segunda fase se realizaron grupos focales, uno con por personas con enfermedad crónica o discapacidad y otros miembros de familias de personas en esta condición de salud. Posteriormente se aplicó una encuesta de resultados para triangulación y saturación de la información, incluyendo otros pacientes y familiares. Resultados Las personas ven como fortalezas el trabajo en equipo por parte de los profesionales, la disposición para la atención, la suficiencia en la información recibida y el uso de estrategias para enseñar procedimientos y aclarar dudas. Como dificultades comunicativas señalaron que el profesional haga presunciones pronosticas negativas o asuma actitudes de distancia o superioridad. Conclusiones En principio se muestra una actitud de aceptación con la comunicación establecida con los profesionales en familiares y pacientes; no obstante, al indagar más específicamente se explicitan los aspectos que pueden mejorar, donde la comunicación puede posibilitar una relación menos jerárquica y más colaborativa, dando espacio a los procesos emocionales.(AU)

Objective Understanding the strengths and difficulties regarding communication between healthcare workers and families and a family member suffering chronic illness or disability, from the perception of patients and families receiving healthcare services. Methods This was a qualitative, interpretative study. The psychological approach adopted was systemic, from a socio-constructionist perspective. The sample was drawn from people contacted at the Universidad de La Sabana’s clinic, Colombia. Question guidelines were based on deductive categories in the first phase; two focus groups were formed during the second phase by people suffering chronic diseases or disability and family members of people in such situation. A survey was then made using the results for data triangulation and saturation, including other patients and relatives. Results People saw professional teamwork, providing care, the sufficiency of the information received and the use of strategies for teaching procedures and answering questions as strengths. They pointed out communication difficulties, like healthcare workers making assumptions about negative prognostics and adopting superior attitudes, or lacking consistency and continuity, as well as high staff turnover. Conclusions Patients and relatives generally adopted an attitude of acceptance concerning the relationship established with healthcare workers; however, when probing more specifically, aspects to be improved were made more explicit, where communication may enable a less hierarchic and more collaborative relationship, providing a space for emotional processes.(AU)

[Patients and relatives’ perception regarding communication with healthcare professionals]. / Percepciones de pacientes y familiares sobre la comunicación con los profesionales de la salud.

OBJECTIVE: Understanding the strengths and difficulties regarding communication between healthcare workers and families and a family member suffering chronic illness or disability, from the perception of patients and families receiving healthcare services. METHODS: This was a qualitative, interpretative study. The psychological approach adopted was systemic, from a socio-constructionist perspective. The sample was drawn from people contacted at the Universidad de La Sabana’s clinic, Colombia. Question guidelines were based on deductive categories in the first phase; two focus groups were formed during the second phase by people suffering chronic diseases or disability and family members of people in such situation. A survey was then made using the results for data triangulation and saturation, including other patients and relatives. RESULTS: People saw professional teamwork, providing care, the sufficiency of the information received and the use of strategies for teaching procedures and answering questions as strengths. They pointed out communication difficulties, like healthcare workers making assumptions about negative prognostics and adopting superior attitudes, or lacking consistency and continuity, as well as high staff turnover. CONCLUSIONS: Patients and relatives generally adopted an attitude of acceptance concerning the relationship established with healthcare workers; however, when probing more specifically, aspects to be improved were made more explicit, where communication may enable a less hierarchic and more collaborative relationship, providing a space for emotional processes.

Bioética ambiental y ecopedagogía: una tarea pendiente / Bioética ambiental e ecopedagogia: uma tarefa pendente / Environmental bioethics and ecopedagogy: the task ahead

El presente trabajo busca recuperar la responsabilidad ambiental como una noción estrictamente bioética y, a su vez, renovar la necesidad de acciones educativas como la única estrategia viable en el marco de una protección ambiental. Examina algunas estrategias pedagógicas y fundamenta las líneas conceptuales generales para una educación ambiental. Como conclusión, señala que es preciso aprender a tomar decisiones de largo plazo, que integren la economía, la ecología, la educación y el desarrollo social como elementos clave en el manejo del tema en un nivel local y regional; no obstante, es necesario crear una cultura ambiental que motive cambios estructurales de comportamiento individual y colectivo. Se trata de un cambio cultural dependiente de la ecopedagogía, que necesariamente propone nuevos comportamientos, herramientas y valores, reflejados en actitudes y estilo de vida verdaderamente consistentes.

This paper attempts at recovering environmental responsibility as a strictly bioethical notion and, at the same time, renew the need for educational activities as the only viable strategy in the context of environmental protection. It examines some pedagogical strategies and provides grounding for conceptual guidelines on environmental education. As a conclusion, it points out that it is necessary to learn how to reach decisions in the long run, integrating economics, ecology, education and social development as key elements for a treatment of the topic at a local and regional levels; it is however necessary to create an environmental culture inducing structural changes in collective and individual behavior. It is a cultural change relying upon ecopedagogics, which necessarily proposes new behaviors, tools and values reflected in attitudes and consistent lifestyles.

O presente trabalho busca recuperar a responsabilidade ambiental como uma noção estritamente bioética e, por sua vez, renovar a necessidade de ações educativas como a única estratégia viável no marco de uma proteção ambiental. Examina algumas estratégias pedagógicas e fundamenta as linhas conceituais gerais para uma educação ambiental. Como conclusão, assinala que é preciso aprender a tomar decisões de longo prazo que integrem a economia, a ecologia, a educação e o desenvolvimento social como elementos chave no manejo do tema em um nível local e regional; não obstante, é necessário criar uma cultura ambiental que motive mudanças estruturais de comportamento individual e coletivo. Trata-se de uma mudança cultural dependente da ecopedagogia, que necessariamente propõe novos comportamentos, ferramentas e valores, refletidos em atitudes e estilo de vida verdadeiramente consistentes.