Dificultades éticas en las organizaciones sanitarias asistenciales públicas / Ethical dilemmas in public health care organizations

Hoy en día cabe preguntarse por una ética de las organizaciones, dado que gran parte de las decisiones de mayor impacto global no se toman desde la perspectiva particular, sino a nivel organizacional. Lo que legitima a cualquier organización es la necesidad social que satisface, y dicha legitimación depende, a su vez, de la calidad del servicio prestado. Y para ofertar un buen servicio las organizaciones deberían tener presente que es necesario hacer bien las cosas, aunque este «hacer bien» no debería limitarse a lo instrumental, sino también a lo ético, lo cual no parece que esté tan presente. Las organizaciones sanitarias asistenciales públicas mantienen un discurso en el que manifiestan promover actitudes y actuaciones éticas, tanto en su funcionamiento interno como en la consecución de sus fines. Pero un mayor conocimiento y análisis de su funcionamiento interno permite poner en cuestión lo anterior. Estas organizaciones, por su estructuración y procedimientos, pueden dificultar que los criterios éticos sean principios rectores en su funcionamiento interno, al tiempo que pueden tener consecuencias éticamente cuestionables a nivel poblacional. Una organización sanitaria no debiera organizarse ni estructural ni funcionalmente como una organización cualquiera que ofrezca servicios, al tiempo que los miembros de la organización no pueden limitarse a ser actores pasivos. Se hace necesario que tanto los profesionales de la organización como los usuarios tengan más conductas pro-éticas, los miembros de la organización desde el profesionalismo y los usuarios desde la responsabilidad (AU)

Today you can ask if you can apply ethics to organizations because much of the greater overall impact decisions are not made by private individuals, are decided by organizations. Any organization is legitimate because it satisfies a need of society and this legitimacy depends if the organization does with quality. To offer a good service, quality service, organizations know they need to do well, but seem to forget that should do well not only instrumental level, must also make good on the ethical level. Public health care organizations claim to promote attitudes and actions based on ethics, level of their internal functioning and level of achievement of its goals, but increased awareness and analysis of its inner workings can question it. Such entities, for its structure and procedures, may make it difficult for ethical standards actually govern its operation, also can have negative ethical consequences at the population level. A healthcare organization must not be organized, either structurally or functionally, like any other organization that offers services. In addition, members of the organization can not simply be passive actors. It is necessary that operators and users have more pro-ethical behaviors. Operators from the professionalism and users from liability (AU)

Academic-industrial relations before the blockbuster drugs: lessons from the Harvard Committee on Pharmacotherapy, 1939-1943.

Increasing discussion has developed in recent years over the nature of the relationship between academic medicine and the pharmaceutical industry. This article narrates the history of a little-known attempt at Harvard Medical School between 1939 and 1943 to establish an interdisciplinary, academic-industrial Committee on Pharmacotherapy to enhance and rationalize the relationship between the field of academic research in pharmacotherapeutics and the pharmaceutical industry. Using original archival materials, the authors depict the functioning of the committee, which was headed by Soma Weiss and included such members as Fuller Albright, Henry Beecher, and Walter Cannon. The committee would be collectively funded by seven pharmaceutical companies and was to be predicated on collaboration, both across the entire university and between academia and industry. It was expected to transform the bench-to-bedside study and testing of therapeutic compounds, to redefine the teaching of pharmacotherapy, and to create a unified forum through which to discuss the overall academic-industrial relationship and more specific issues such as patents. Unfortunately, the program proved to be short-lived, the victim of such contingent factors as the untimely death of Soma Weiss and America's entry into World War II, as well as such more fundamental factors as the inadequate and temporary nature of the funding stream and unresolved tensions regarding the goals of the committee on the part of both the medical school and its industry supporters. Nevertheless, these early forays into collaborative bench-to-bedside translational research and the rationalization of academic-industrial relations remain instructive today.

Ethical vulnerabilities in nursing history: conflicting loyalties and the patient as 'other'.

The purpose of this article is to explore enduring ethical vulnerabilities of the nursing profession as illustrated in historical chapters of nursing's past. It describes these events, then explores two ethical vulnerabilities in depth: conflicting loyalties and duties, and relationships with patients as 'other'. The article concludes with suggestions for more ethical approaches to the other in current nursing practice. The past may be one of the most fruitful sites for examining enduring ethical vulnerabilities of the nursing profession. First of all, professional identity, which includes moral identity, comes in part from knowledge of the nursing profession's past. Second, looking to the past to understand better how events and ideologies have brought vulnerabilities to the fore raises questions about ethical nursing practice today.

IPA - Cem anos de resistência / IPA - Cien años de resistencia / IPA - A hundred years of resistance

O texto trabalha a fundação da IPA em seus detalhes históricos e as vicissitudes que presidiram seu nascimento. Todos os personagens fundamentais que construíram essa Associação circulam - com suas aproximações e rivalidades - na construção dessa Associação, assim como o porquê da sua imprescindibilidade. A constituição do chamado "Comitê Secreto", por um lado, e a presença do "Estrangeiro" por outro, possibilitam constituir um par dialético em que o endogâmico rivaliza com exogâmico. O "estrangeiro" é o lugar de Jung, o exogâmico, enquanto o "Comitê Secreto" é o endogâmico. Em outros termos, um está constituído para vigiar o outro. Finalmente, a ética da fidelidade é substituída pela ética da liberdade.(AU)

El texto trabaja la fundación de la IPA con detalles históricos y vicisitudes que presidieron su nacimiento. Todos los personajes fundamentales que construyeron esa Asociación figuran - con sus aproximaciones y rivalidades - en la construcción de esa Asociación así como el motivo de su indispensabilidad. La constitución del llamado "Comité Secreto", por un lado y la presencia de lo "Extranjero" por el otro, pudieron constituir un par dialéctico donde el endogámico rivaliza con el exogámico. El "extranjero" es el lugar de Jung, mientras que el "Comité Secreto" constituye el endogámico. Dicho de otro modo, uno está constituido para vigilar al otro. Finalmente, la ética de la fidelidad es substituida por la ética de la libertad.(AU)

The text deals with the foundation of IPA in its historical details and the problems that appeared before its birth. All the essential people who built this Association wander - with their similarities and antagonisms - in the building of the Association, as well as the reason for its vital indispensability. The establishment of the so-called "Secret Committee", on one hand, and the presence of the "Foreigner", on the other, allow for the constitution of a dialectic pair, where the endogamous rivals the exogamous. The "Foreigner" is Jung’s territory, the exogamous, while the "Secret Comitee" is endogamous. In other words, each is built to watch the other. Finally, the ethics of fidelity is substituted by the ethics of liberty.(AU)

IPA - Cem anos de resistência / IPA - Cien años de resistencia / IPA - A hundred years of resistance

O texto trabalha a fundação da IPA em seus detalhes históricos e as vicissitudes que presidiram seu nascimento. Todos os personagens fundamentais que construíram essa Associação circulam - com suas aproximações e rivalidades - na construção dessa Associação, assim como o porquê da sua imprescindibilidade. A constituição do chamado "Comitê Secreto", por um lado, e a presença do "Estrangeiro" por outro, possibilitam constituir um par dialético em que o endogâmico rivaliza com exogâmico. O "estrangeiro" é o lugar de Jung, o exogâmico, enquanto o "Comitê Secreto" é o endogâmico. Em outros termos, um está constituído para vigiar o outro. Finalmente, a ética da fidelidade é substituída pela ética da liberdade.

El texto trabaja la fundación de la IPA con detalles históricos y vicisitudes que presidieron su nacimiento. Todos los personajes fundamentales que construyeron esa Asociación figuran - con sus aproximaciones y rivalidades - en la construcción de esa Asociación así como el motivo de su indispensabilidad. La constitución del llamado "Comité Secreto", por un lado y la presencia de lo "Extranjero" por el otro, pudieron constituir un par dialéctico donde el endogámico rivaliza con el exogámico. El "extranjero" es el lugar de Jung, mientras que el "Comité Secreto" constituye el endogámico. Dicho de otro modo, uno está constituido para vigilar al otro. Finalmente, la ética de la fidelidad es substituida por la ética de la libertad.

The text deals with the foundation of IPA in its historical details and the problems that appeared before its birth. All the essential people who built this Association wander - with their similarities and antagonisms - in the building of the Association, as well as the reason for its vital indispensability. The establishment of the so-called "Secret Committee", on one hand, and the presence of the "Foreigner", on the other, allow for the constitution of a dialectic pair, where the endogamous rivals the exogamous. The "Foreigner" is Jung’s territory, the exogamous, while the "Secret Comitee" is endogamous. In other words, each is built to watch the other. Finally, the ethics of fidelity is substituted by the ethics of liberty.

Shifts in guidelines for ethical scientific conduct: how public and private organizations create and change norms of research integrity.

We analyze the activities and actors involved in articulating and diffusing guidelines for ethical scientific conduct from 1975 to the present. We use a theoretical framework of institutional change at the organizational-field level to examine the co-evolution of the structure of the organizational field of 'scientific research' and its institutional logic. Public agencies have long provided funding to US universities to support faculty research, expecting that implicit norms of scientific conduct would guide behavior. Growing publicity about research fraud in the late 1960s and early 1970s triggered a shift from implicit norms to explicit behavioral proscriptions, with strong administrative oversight. As private sources of research funding exert new pressures on research behavior, public-private partnerships are emerging to articulate explicit, yet voluntary prescriptive norms of research integrity. The analysis demonstrates the co-evolution and co-dependence of changes in the identity and strength of influential actors in the field of scientific research and changes in the norms of scientific conduct. We examine how the normative guidelines have been constructed over time, illustrating the persistence of earlier norms as the foundation for current guidelines. We conclude with implications for future research conduct.

Viajes y memoria: las ciencias en España antes y después de la Guerra Civil / Travels and memory: the sciences in Spain before and after the civil war

Este artículo repasa la influencia de la Junta para Ampliación de Estudios y el efecto de la políticade pensiones en el extranjero en la trayectoria del Consejo Superior de Investigaciones Científicas.Se proponen el viaje de los pensionados de la JAE como fuente de saber científico y de susprácticas. Se sugiere que la memoria institucional, como la de las ideas, no se borra en guerrasciviles y dictaduras, por represoras que sean, que hay genealogía también de las prácticas de lasciencias y en la formación experimental a lo largo del siglo xx en España

This essay revisits the influence of the Junta para Ampliación de Estudios (JAE), the effect inthe trajectory of the Consejo Superior de Investigaciones Científicas of JAE grants and scholarshipspolicy for Spanish young graduates to study abroad. It proposes grantee’s travel as a source ofknowledge and its practices. It develops the argument that institutional memory, as that of ideas, isnot blurred by either a civil war or a dictatorship, repressive as it was. It also suggests genealogy ofscientific practices and training during the 20th century in Spain (AU)

Pedro Martín Martínez, profesor de anatomía del Hospital General de Madrid / Pedro Martín Martínes, professor of Anatomy at the General Hospital of Madrid

OBJETIVO: El estudio de las obras anatómicas escritas por Martín Martínez y su relación con la Urología. Así como, la apreciación de su abierta mentalidad científica y escéptica en un entorno histórico aún imbuido de escolasticismo y dogmatismo. MÉTODOS: Se revisaron algunas obras de Martín Martínez, principalmente el tratado Anatomía Completa del Hombre, texto íntegro obtenido de la página electrónica de la Biblioteca de la Universidad Complutense de Madrid, y las obras de otros autores de su tiempo. RESULTADOS: Se constata la personalidad médica y filosófica de Martín Martínez y su influencia en el saber médico del primer cuarto del siglo XVIII en la Corte Española. Se aprecia la importancia que tuvo, como Profesor de Anatomía, en el funcionamiento y desarrollo del Anfiteatro Anatómico madrileño del Hospital General y su repercusión positiva en la formación de estudiantes y cirujanos de su época y de años posteriores. A ello contribuyó el que sus obras estuvieran escritas en castellano. CONCLUSIONES: Aunque no se le puede considerar como una personalidad científica sobresaliente, comparado con autores de otros países europeos, hay que reconocerle gran mérito por su labor aperturista y antidogmática ante la mentalidad médica estancada en el «servilismo» y en el estudio de los autores clásicos de siglos anteriores (AU)

OBJECTIVES: The study of the anatomical works written by Martín Martinez and his relationship with urology. Also, the appreciation of his open scientific mentality and scepticism in a historic environment imbued of a scholastic spirit and dogmatism. METHODS: Several Martin Martinez’s works were reviewed, mainly the treaty Complete human anatomy, entire text obtained from the electronic page of the Complutense University library, and also the words from other authors of his time. RESULTS: The medical and philosophical personality of Martin Martinez and his influence in the medical knowledge in the Spanish Court during the first quarter of the 18th century are ascertained. The importance he had as Professor of anatomy in the functioning and development of the Madrid’s Anatomical Amphitheater in the General Hospital and his positive repercussion on the training of students and surgeons of that time and posterior years is appreciated. Writing his works in Spanish contributed to it. CONCLUSIONS: Although he cannot be considered an outstanding scientific personality in comparison with authors from other European countries, he must be recognized for his great merit with his open mind and his labour against dogmatism in front of the blocked-in-servility medical mentality, and also in the study of classic authors from previous centuries

The ethics of farming-out: ideology, the state, and the asylum in nineteenth-century Quebec.

This article traces the development of the farming-out system of asylum provision which emerged in Quebec for the treatment and care of those who were considered to be insane. The kind of asylum provision that developed in Quebec was met with strong criticism by alienists elsewhere in Ontario, Britain and the United States who considered farming-out to be highly unethical. These criticisms were not lost on the state which tried to exercise increased control over the daily affairs of the asylum. But for much of the nineteenth century the state largely failed in these efforts. The community response to the rise of the farming-out system further complicated the role of the state in the management and control of insanity. I argue that the farming-out system is best considered as the product of complex relations between the state officials, alienists, and community members. This understanding of asylum development in Quebec has important implications for the study of the nineteenth-century state formation.