[Action before ethical dilemmas in the consultation after divorce. Role of the minor according to age and level of maturity]. / Actuación ante los dilemas éticos en la consulta tras divorcio. Papel del menor según edad y nivel de madurez.

Lately, number of divorces is increasing, nevertheless, a parents' divorce can become a traumatic problem for paediatric patients. Consequently, the aim of this study was to analyze the ethical conflicts that appear in the relationship between physician/parents/son/daughter, and more specifically those that a divorce generates. A descriptive study was developed through a survey composed by 39 items. Previously, an exhaustive bibliographic analysis was carried out. Our results show that only 35% of paediatricians interviewed have been educated in bioethics although this issue is important in daily practice. Other items show that 57,5% would not cancel a pharmacological treatment in order to improve quality of life. Also, they would react against a wrong parents' decision (82,5%). They give low value to the minor`s decision (6,05%), and rarely inform exclusively to adolescents (5%). In contrast, paediatricians sometimes ask to adolescents (20%) in first place and involved them to decide in 90% of cases. Besides, there are differences in the relation with fathers and mothers, 17,5% of mothers are informed exclusively, a fact that never happens with fathers. Ethics has an intrinsic value very important in daily clinical decisions in order to respect the rules and to adapt them to the situation of every paediatric patient. When an important ethical conflict become, as a divorce is, it is essential to know who must be informed and the rights everyone has to make a decision. It is complicated to the paediatricians yet to develop 41/2002 law for Patient's autonomy.

Actuación ante los dilemas éticos en la consulta tras divorcio. Papel del menor según edad y nivel de madurez / Action before ethical dilemmas in the consultation after divorce. Role of the minor according to age and level of maturity

En los últimos años el número de divorcios ha ido aumentando, siendo en ocasiones, para el paciente pediátrico, el divorcio de sus padres un elemento traumático. Nuestro objetivo fue analizar los conflictos éticos que se producen en la relación sanitaria médico-padres-hijo y de forma más específica en niños procedentes de separación/divorcio. Se realizó un estudio descriptivo mediante una encuesta compuesta de 39 items. Previamente se realizó un análisis bibliográfico exhaustivo de artículos relacionados. Nuestros resultados muestran que solo el 35% de los pediatras ha recibido formación en bioética pese a su importancia en la práctica diaria. Sobre otras cuestiones, la mayoría (57,5%) no retiraría el tratamiento de un paciente enfermo pese a que aumentara su calidad de vida, y actuaría ante una decisión equivocada de los padres (82,5%). Dan poco valor a las decisiones del menor (6,05%), raramente informados exclusivamente (5%). En cambio, se les informa primero en un 20% de los casos y en el 90% se les implica. Respecto a los progenitores, el 17,5% de las madres son informadas en exclusiva, nunca los padres. La ética tiene un valor intrínseco muy importante en las decisiones clínicas habituales, respetándose generalmente las normas y adaptándose a la situación particular de cada niño/a. En los casos en los que hay un conflicto importante, como divorcios, es importante conocer a quién se debe informar, y qué derecho tiene cada uno a decidir. Aún resulta difícil para algunos pediatras aplicar la ley 41/2002 de Autonomía del Paciente

Lately, number of divorces is increasing, nevertheless, a parents' divorce can become a traumatic problem for paediatric patients. Consequently, the aim of this study was to analyze the ethical conflicts that appear in the relationship between physician/parents/son/daughter, and more specifically those that a divorce generates. A descriptive study was developed through a survey composed by 39 items. Previously, an exhaustive bibliographic analysis was carried out. Our results show that only 35% of paediatricians interviewed have been educated in bioethics although this issue is important in daily practice. Other items show that 57,5% would not cancel a pharmacological treatment in order to improve quality of life. Also, they would react against a wrong parents' decision (82,5%). They give low value to the minor`s decision (6,05%), and rarely inform exclusively to adolescents (5%). In contrast, paediatricians sometimes ask to adolescents (20%) in first place and involved them to decide in 90% of cases. Besides, there are differences in the relation with fathers and mothers, 17,5% of mothers are informed exclusively, a fact that never hap-pens with fathers. Ethics has an intrinsic value very important in daily clinical decisions in order to respect the rules and to adapt them to the situation of every paediatric patient. When an important ethical conflict become, as a divorce is, it is essential to know who must be informed and the rights everyone has to make a decision. It is complicated to the paediatricians yet to develop 41/2002 law for Patient's autonomy

Caso: Riesgo de aborto en mujeres susceptibles y apoyo socio-familiar. Dos casos clínicos contrapuestos / Case: risk of abortion in susceptible women and socio-family support. Two opposing clinical cases

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Dilemas éticos en la práctica de la medicina infantil / Ethical dilemmas in practice of medicine child

Tras revisar la bibliografía existente en los últimos 20 años se aprecia un déficit de información sobre los conflictos éticos que afectan a los pediatras en su práctica diaria lo que provoca cierto grado de incertidumbre en estos profesionales a la hora de resolver estos problemas. Por este motivo se realizó una búsqueda sistemática en las principales bases de datos encontrando más de 150 artículos relacionados con este asunto, de los que se seleccionaron 80 considerados como los más relevantes. Tras estudiarlos, se encontraron 40 dilemas éticos relacionados con algún principio de solución y que se describen en este artículo. Entre ellos destacan algunos dilemas éticos relacionados con incapacidades, o con cuidados paliativos en medicina infantil, o el dilema del consentimiento informado en este rango de edad

After reviewing the existing bibliography in the last 20 years, we concluded that there is a lack of information regarding the ethical conflicts that affect to pediatrics in their daily practice. It produces certain degree of uncertainty in these professionals at the time of solving these problems. We made a systematic search in the main data bases, finding more than 150 articles related, of which 80 were considered outstanding. After studying them, we have found 40 ethical dilemmas, related to some principle of solution and that we described in this article. Through them we can find such important dilemmas as those related to physical disability, palliative care or consent from children

[Ethical Dilemmas in Practice of Medicine Child]. / Dilemas Éticos en la Práctica de la Medicina Infantil.

After reviewing the existing bibliography in the last 20 years, we concluded that there is a lack of information regarding the ethical conflicts that affect to pediatrics in their daily practice. It produces certain degree of uncertainty in these professionals at the time of solving these problems. We made a systematic search in the main data bases, finding more than 150 articles related, of which 80 were considered outstanding. After studying them, we have found 40 ethical dilemmas, related to some principle of solution and that we described in this article. Through them we can find such important dilemmas as those related to physical disability, palliative care or consent from children.

[Informed Consent in the Humanization of the Cesarean: A Preliminary Study]. / Consentimiento Informado en la Humanización de la Cesárea: Un Estudio Preliminar.

The informed consent (IC) is a process based on dialogue between the professional and the patient in which he freely decides on possible interventions in their health. This is applicable to caesarean delivery and if it meets a number of conditions will help to improve the process of ″humanization″ of birth. The overall objective of this study is to analyze preliminarily in several hospitals in the Region of Murcia the IC in caesarean delivery. To this end, we have revised the documents of IC and we studied who, where, when and how the IC process is done. The results show that all hospitals are based on the same document, and although the documents take into account all the elements of a IC, do not indicate the date of their design or subsequent revisions. It does not contemplate the risks and complications that caesarean section can have on the newborn, mother, and mother-child relationship later. It is noted that the document of IC normally is delivers by gynecologist in the consultation, when intervention is programmed, although it are sometimes nurses, who after admission to the hospital give it to sign the patient. In urgent caesarean sections, there are some hospitals that in life-threatening situation, do not offer the document of IC to women. In others, it is offered hastily by the gynecologist or midwife. In conclusion, the IC is a process which used correctly, favors the relationship between women and health professionals in the intervention of cesarean section. Although this process and the documents of IC examined in our study, have presented many positive aspects, the humanization of caesarean could be increased improving with the preparation and updating of these documents and coordinating the various professionals.

Consentimiento informado en la humanización de la cesárea: un estudio preliminar / Informed consent in the humanization of the cesarean: a preliminary study

El consentimiento informado (CI) es un proceso basado en el diálogo entre el profesional y el paciente en el que éste decide libremente sobre las posibles intervenciones en su salud. Éste es aplicable al nacimiento por cesárea y siempre que cumpla una serie de condiciones ayudará a la mejora del proceso de 'humanización' del nacimiento. El objetivo general de este estudio es analizar de forma preliminar el CI de las cesáreas en varios hospitales de la Región de Murcia. Para ello hemos revisado los documentos de CI y hemos analizado quién, dónde, cuándo y cómo se realiza el proceso del CI. Los resultados muestran que todos los hospitales parten de un mismo documento y, aunque los documentos tienen en cuenta todos los elementos de un CI, no indican la fecha de su diseño ni las revisiones posteriores. Tampoco contemplan los riesgos y complicaciones que la cesárea puede tener en el recién nacido, la madre y la posterior relación madre-hijo. Se observa que el documento de CI normalmente lo ofrece el ginecólogo en la consulta, cuando la intervención es programada, aunque en ocasiones es el personal de enfermería quien después del ingreso en el hospital se lo da a firmar a la paciente. En cesáreas urgentes hay algunos hospitales que se acogen a la situación de riesgo vital y no ofrecen el CI a la mujer. En otros se ofrece haciéndolo el ginecólogo o la matrona de forma apresurada. En conclusión, el CI es un proceso que empleado de forma correcta favorece la relación entre la mujer y los profesionales sanitarios en la intervención de la cesárea. Aunque este proceso y los documentos utilizados en él, presentan en nuestro estudio, muchos aspectos positivos, la humanización de la cesárea podría incrementarse mejorando tanto la confección y actualización de estos documentos como coordinando a los diversos profesionales que participan en este proceso de CI

The informed consent (IC) is a process based on dialogue between the professional and the patient in which he freely decides on possible interventions in their health. This is applicable to caesarean delivery and if it meets a number of conditions will help to improve the process of 'humanization' of birth. The overall objective of this study is to analyze preliminarily in several hospitals in the Region of Murcia the IC in caesarean delivery. To this end, we have revised the documents of IC and we studied who, where, when and how the IC process is done. The results show that all hospitals are based on the same document, and although the documents take into account all the elements of a IC, do not indicate the date of their design or subsequent revisions. It does not contemplate the risks and complications that caesarean section can have on the newborn, mother, and mother-child relationship later. It is noted that the document of IC normally is delivers by gynecologist in the consultation, when intervention is programmed, although it are sometimes nurses, who after admission to the hospital give it to sign the patient. In urgent caesarean sections, there are some hospitals that in life-threatening situation, do not offer the document of IC to women. In others, it is offered hastily by the gynecologist or midwife. In conclusion, the IC is a process which used correctly, favors the relationship between women and health professionals in the intervention of cesarean section. Although this process and the documents of IC examined in our study, have presented many positive aspects, the humanization of caesarean could be increased improving with the preparation and updating of these documents and coordinating the various professionals

[An approach to abortion and immigration in Spain. The social economic value of the human life]. / Una aproximación al aborto e inmigración en España. El valor socioeconómico de la vida humana.

This paper enters the analysis of the phenomenon of the abortion in Spain, across the study of the reasons of his practices in the group of immigrant women resident in Murcia. The following aims appear are: a) know the prevalence of abortions in the immigrant population of an urban center of primary care health in the state of Murcia, b) know the personal attitude before this population's c) analized abortion this population's socio-economic and religious characteristics and to value their possible relationship with the abortion. The material and method used form a descriptive traverse study, carried out in primary care (Center of primary care San Andrés-state of Murcia) carried out during the months of June to December of 2007. 230 women were included. The collection of data was made by means of interview clinic carrying out a survey semistructured with open and closed questions, in total 14 items, enlarged to 23 items in case one declares voluntary abortions. The Results show us as the fundamental motives for those who are aborted they were the lack of economic means, the disadvantages for his personal projects and the pressure on the part of his pair or family. The conclusions, force first, from the bioethic reflection, to the denunciation of the political- social inaction with regard to the abortion and the ideological manipulation of the socioeconomic reasons of the same practices; and secondly, to the promotion of networks of help to the embarrassed woman and to the public defense of the absolute value of the human life.