[Euthanasia and assisted suicide in people with mental disorders]. / Eutanasia y suicidio asistido en personas con enfermedad mental.

Until 2020, only Belgium, Luxembourg, Switzerland, and the Netherlands admitted, under differentiated legal coverage, requests for euthanasia and / or assisted suicide in patients with non-terminal illnesses, and for reasons of intractable and unbearable suffering. Since March 2021 this is also possible in Spain. The objective of this work is to review the existing studies and characteristics of the practice of euthanasia and assisted suicide (ESA) in people with mental disorders (TM) and / or dementia (D) and see if the legal requirements essential in ESA applications in these patients are to be met. The hypothesis is that compliance with these requirements is especially difficult in patients with TM-D, either because of the characteristics of the disease itself, or because of the recognized legal security failures. Likewise, there may be sources of fraud not actually prosecuted by the State, either due to the complicity of society and / or due to the necessary cooperation of Medicine. As a result of this review, we raise criticaethical-deontological considerations about the approval of ESA for patients with TM-D, and its errors and consequences, to the reflection of the readers. We propose as an alternative to ESA the so-called ″palliative psychiatry″, which aims at improving the quality of life of patients and their families by facing the problems associated with severe persistent mental illness -potentially fatal- through the prevention and relief of suffering.

[The Identity of Medicine in the Thought of Edmund D. Pellegrino]. / Identidad de la Medicina en el Pensamiento de Edmund D. Pellegrino.

This essay addresses Pellegrino's thought on Philosophy of Medicine; it also provides an approach to his concerns on the changing relationship between patients and physicians which took place in the late twentieth century in the United States and, finally, to his contribution to the identity of Medicine debate. From an Aristotelian-Thomist way of thinking, and from a phenomenological approach to the medical act, he identifies the ending of Medicine and also its limits concerning to ″healing″, in his two moments, curing and helping, which includes caring. Medicine, the essence of Medicine, tends to healing, for this relationship between patient and physician tends to a ″good″ which ultimately ends up being its finality. Medical ethics germinates within this relationship, the clinical encounter, as a universal experience of illness, pain and humane limitation. Therefore, healing is the essence of Medicine and truly its genuine identity. Besides healing any other act is not strictly medical. From the doctrine of Pellegrino emerges that original and classic idea of ″the good of the patient″ as the main and ruling principle of medical ethics. Medical act is no longer just a technique, a technical act, but also a moral enterprise, which our teacher relates to the so called ″medical virtues″. But this ″good″ may not be understood nowadays in the old Hippocratic terms and should also be related to the dignity of the patients and to his or her moral autonomy. And accordingly an updating of the concept of good is demanded by the teacher who, to this intent, stresses four main aspects which are summoned in the article.

[An approach to the thinking of Edmund D. Pellegrino (I)]. / Una Aproximación al Pensamiento de Edmund D. Pellegrino (I).

This essay contains an approach to the moral thinking of Pellegrino. This first part addresses the elementary sources of Medicine identity, as seen by the author, which was the starting point for his research on the role of both physicians and Medicine, and led him to his proposal to reform medical ethics. His thinking is developed in four different scopes: 1) the ideal of medical education; 2) Medicine as a moral enterprise; 3) the medical humanities in the formation and professional life of physicians; 4) the philosophy of Medicine as source and origin of medical ethics.

[Portrait of a teacher]. / Semblanza de un Maestro.

Some biographical data are given about the life of Edmund D. Pellegrino, his modest origins, his effort to get to study Medicine and an overview to his professional life as internist physician, Medicine professor and writer, besides his multiple nominations and high-responsibility appointments in healthcare institutions, medical schools and universities throughout the United States. There are several mentions of his impressive resume and of the numerous tributes he received, as well as appointments and distinctions, and finally, it is also stressed his extraordinary contribution to clinical bioethics. His last decades at Georgetown University and his creative contribution to reform medical ethics led him to achieve a legendary prestige.

[Self-effacement]. / Self-effacement o desprendimiento altruista.

The authors reflect around a medical virtue much needed in estimating the doctor-patient relationship in our time, they call "self-effacement". That is, the attitude and disposition of medical professional to be faithful to the trust placed in him patient, always willing to help and search for their best interests. Whenever decisions respected and physician conscience is maintained.

[The virtues in clinical bioethics]. / Las Virtudes en Bioética Clínica.

The return to the virtuous physician, in medical ethics, is the key point of the ethical model proposed by Pellegrino. Following MacIntyre thinking, Pellegrino introduces the "medical virtues" concept, alma mater idea of his reforming proposal. This article describes the thinking of the author from three different outlooks: 1) an approach to the theory of virtue; 2) the ends of Medicine and virtues; and 3) professionalism and the virtues ethics. Finally, summing up his vision on 'virtue', it describes his vision of Christian virtues in medical practice along with the virtue of self-effacement of physician, though directs to specific articles where these issues are addressed in the monography.

[An approach to the thinking of Edmund D. Pellegrino (II)]. / Una Aproximación al Pensamiento de Edmund D. Pellegrino (II).

This second approach to the doctrine and thinking of Edmund D. Pellegrino presents the basics of the author's proposal to reform medical ethics, based on the rehabilitation of beneficence principle in health care. It describes the research and interest of our bioethicist towards the concept of 'good' of the patient and his four components. Pellegrino's classic concepts of 'healing' and 'help' are also analyzed, as distinctive aspects of the new ethics structure. Ultimately, the debate about the identity of Medicine is also introduced, along with the concepts of essentialism and its social constructivism, a capital issue for the author for the future of Medicine.

[The Christian virtues medical practice]. / Las Virtudes Cristianas en la Práctica Médica.

The return to an ethic of virtues in dialogue with the moral tradition of Medicine and biomedical ethics is the backbone of Pellegrino's proposed reform of medical ethics. The question why this author proposes this reform is answered in this paper that summarizes his book "The Christian Virtues in Medical Practice". Perceiving the changes in the practice of medicine in their country, Pellegrino and Thomasma, men of deep faith, concerned about the darkening of medical conscience and the intuition of danger to the Christian faith, they address the commitment of Christian physicians and those who join them in the mode and form of practicing medicine. Deeply loyal to the Gospel message, the book represents a wake-up call to the conscience of believing professionals, leading to a demanding, enriching and committed vision of the practice of medicine.