[Knowledge of the Advance Directive (AD) in Physicians at Tertiary Care Hospitals]. / La «voluntad anticipada¼ y su conocimiento por médicos en hospitales de tercer nivel.

UNLABELLED: The Advance Directive is generally conceptualized as the respect that all human beings deserve in the use of their faculties, to deliberate, choose, and decide upon everything that pertains to their existence, including their life goals and personal health. OBJECTIVE: To identify knowledge about the AD that Medical Residents at tertiary care facilities of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS) in the District Capital (Mexico City), possess. METHOD: Written survey with 10 questions for Medical Residents (MR) of different specialties at tertiary care hospitals. STUDY DESIGN: Survey. RESULTS: The questionnaire was applied to 280 MR of more than ten different specialties, at the La Raza and the S XXI Medical Centres (Centro Médico La Raza y Centro Médico Siglo XXI). The majority of respondents were first-year MR (67.5%), and the minority were sixth-year Residents (1.9%). Incomplete knowledge about the Federal AD Law exists. DISCUSSION: In Mexico, like on an international plane, the contemporary, social dynamic has fundamentally influenced the practice of healthcare professions. The responsibilities that health care professionals take on obligate them to be current in areas like the rights of healthy and sick individuals to be involved in and decide on aspects related to the phase at the end of their lives. The AD, Vital Testament, Living Will, will push doctors to improve the doctor-patient relationship since the establishment of an AD is not possible without a good patient-doctor rapport.

[Expression of the concept of death by residents of a tertiary hospital]. / Expresión del concepto de muerte por médicos residentes de un hospital de tercer nivel.

INTRODUCTION: Attitudes of health professionals are based on their conditions and personal life experiences about life and death and are part of their professional behavior. Medical training relies mainly on physical-biological sciences and, to a lesser extent, on social-medical aspects, thus forming the physician's concept about death. These concepts may present themselves as a result of culture and as factors that model or limit the cognitive development of the physicians. OBJECTIVE: To determine the concept of death of medical residents in a high-specialty hospital. METHODS: A cross-sectional, prospective survey of physicians in training from the first to the sixth year from different specialties. Descriptive statistical analysis was carried out. RESULTS: We made 174 surveys; 61% were in the first year of the specialty; 149 practiced some religion. Women were 3.5 times more likely to have a concept of death that was not that of a biologist, unlike men. Women were 25% more likely to have had an influence of religion on their concept of death. CONCLUSIONS: The personality of the physician is versatile. It has a relationship with professional and human experiences. As training progresses, medical influence transforms biological or religious views. The concept of death and its influence on the idea appeared to be different between male and female physicians.

[Ethics and teaching medicine. A principles declaration]. / Declaración de principios éticos del educador en medicina.

Medicine is an old profession, having existed for twenty-four centuries. The ethical principles assumed since the beginning and have been enriched through time, culture and tradition. The stone corner of the moral commitment of physicians with the patient and medical students has deteriorated due to a values crisis. This is due to a lack of personalized and humanized care in "altars of progress," characterized by fragmentation of medical care, excessive use of the technology and merchandizing of medicine, where profits is a priority over human need. The effects are unconsciousness and a lack of professional values, which are expressed as disloyalty, deficient solidarity, diminution of confidence, inequality and lack of honesty, affecting the patients and the whole medical relation. The problem also extends to medical education, when the students follow the same way to practice of physicians. To be a real educating physician in medicine implies an indissoluble educational symbiosis (teacher-student). When there is an ethical deterioration the immediate task is to propose alternative ethical and morals rules in medical education, which feed on values and traditional medicine principles.

[Medical knowledge validity: an approximation]. / La validez del conocimiento médico: una aproximación.

The fulfillment of their professional responsibilities as necessity, prevent to physicians sometimes to reflect upon medical scientific knowledge validity. In this paper some reflections about it are made considering the importance of integral vision of medicine for the physicians. This knowledge result of scientific development and special application methods. The reflection on medical scientific knowledge validity is different from its historical or ethical valuation. The author point out four dimensions strongly connected on such validity: construct which result of theorical and empirical validity, and consensus validity. The four dimensions are modified for diverse factors.

Reflexiones bioéticas: necesidad de promover actitudes altruistas hacia la investigación médica en seres humanos / Bioethical reflections: Necessity to promote altruistic attitudes toward on medical research in human beings

In this paper some bioethical reflections about medical research in human beings are made. The social moral obligation to increase this kind of investigation, with the purpose of enlarging resources to take care of the health of society, as well as to comply with the moral duty of keeping the integrity of the participating subjects, have placed to medical investigators face to face with ethical problems that may affect the development of this essential activity for human healthcare. On one hand, in the present context, the resistance of both healthy and sick individuals to collaborate in the studies, as possible, according to a wrong autonomous decision (irreflexive individualism). On the other hand, the shortage of anticipating strategies that promotes altruistic attitudes to take into account, the suffering experiences proper of human nature. In this regard, the author focuses his reflections, from the principle of social welfare that underlies medical research and of the necessity of providing instrumentation for some educational policy that without lacking respect for the autonomy of subjects, would propitiate the participation of society so that humanity would continue to benefit from the achievements of this type of research.

La necesidad de realizar investigación médica en seres humanos, con el fin último de incrementar el acervo de bienes para la atención a la salud de la humanidad, así como el deber moral de mantener la integridad física y psíquica de quienes participan en los estudios, coloca a los investigadores médicos, frente a problemas que a la luz del análisis bioético plantea nuevas dificultades, ampliando el ámbito de la reflexión bioética, en el contexto de la sociedad contemporánea. Un problema importante es que existe el riesgo de que paulatinamente las personas sanas o enfermas se nieguen a colaborar en los estudios de manera espontánea, producto en gran parte de una actitud individualista que resulta del ejercicio irreflexivo de la autonomía personal. Otro problema estrechamente relacionado es la carencia de estrategias que prevengan esta situación, a través de la promoción de actitudes altruistas, sin detrimento de la autonomía personal. El autor propone lineamientos generales para la instauración de una política educativa considerando por un lado las experiencias y vivencias propias de la condición humana y, por otro, las responsabilidades sociales de los individuos, desde la perspectiva del principio de beneficencia social que subyace en la investigación médica.

[Bioethical reflections: necessity to promote altruistic attitudes toward medical research in human beings]. / Reflexiones bioéticas: necesidad de promover actitudes altruistas hacia la investigación médica en seres humanos.

In this paper some bioethical reflections about medical research in human beings are made. The social moral obligation to increase this kind of investigation, with the purpose of enlarging resources to take care of the health of society, as well as to comply with the moral duty of keeping the integrity of the participating subjects, have placed to medical investigators face to face with ethical problems that may affect the development of this essential activity for human healthcare. On one hand, in the present context, the resistance of both healthy and sick individuals to collaborate in the studies, as possible, according to a wrong autonomous decision (irreflexive individualism). On the other hand, the shortage of anticipating strategies that promotes altruistic attitudes to take into account, the suffering experiences proper of human nature. In this regard, the author focuses his reflections, from the principle of social welfare that underlies medical research and of the necessity of providing instrumentation for some educational policy that without lacking respect for the autonomy of subjects, would propitiate the participation of society so that humanity would continue to benefit from the achievements of this type of research.

Medicina paliativa en pacientes en fase terminal / Palliative medicine in terminal patients

En este trabajo se hacen algunas reflexiones acerca del uso de la medicina paliativa en los pacientes que se encuentran en fase terminal. Todo ello en el marco de la responsabilidad moral del equipo de atención a la salud, en cuanto a la necesidad de atender al paciente en función de su propio interés, del respeto a sus derechos morales y persiguiendo siempre el objetivo fundamental de la medicina, que es la procuración del bienestar físico-mental y social de los individuos, considerando, entre otras cosas, que la búsqueda del bienestar humano como valor moral tiene su fundamento ético en la filosofía de la Antigüedad clásica.

La bioética y la crisis de la ética médica tradicional / Bioethics and the crisis of traditional medical ethics

En este trabajo se hace una reflexión sobre la crisis que actualmente vive la ética médica tradicional y cuyos preceptos fundamentales están influidos por el llamado Juramento Hipocrático, documento anónimo antiguo de origen griego. Luego de un breve análisis sobre este documento, en donde se explica el porqué de la crisis de su operancia y de la pérdida de la vigencia de muchos de sus preceptos -desde tiempos pasados, hasta la época actual -, el autor invita al personal médico a que haga de la reflexión un quehacer cotidiano, incorporándose al estudio de las humanidades médicas, tratando de dar respuesta a un sinfín de preguntas que surgen ante la crisis. Señala el autor que dicha tarea es impostergable, si el médico se siente realmente comprometido consigo mismo y con la sociedad.

El estudio de humanos y sus implicaciones éticas / Ethical implications in study of hujman beings

En este trabajo se hacen diferentes consideraciones acerca de las implicaciones éticas del estudio de humanos, a partir de su desarrollo histórico. Se señala la frecuencia con que ésto se han realizado desde que se impulsó el uso del método científico, orientado hacia la solución de problemas de salud de la población humana, así como las omisiones de carácter ético que, sobre el particular, dieron origen a una serie de códigos y declaraciones de hoy día, privilegian el estado de salud de los sujetos experimentales por encima de los intereses de la ciencia. También se menciona la importancia de ha tenido la Bioética para impulsar la reflexión ético-filosófica sobre la investigación además de promover la formación de comités de bioética en todas las instituciones donde se realiza, y de programar campañas sociales para la participación altruista en proyectos de investigación que redunden en beneficio de la salud humana