Consentimiento informado y directivas anticipadas: análisis comparado de la legislación en América Latina / Consentiment informat i directives anticipades: anàlisi comparada de la legislació a Amèrica Llatina / Informed consent and living wills: comparative analysis of the legislation in Latin America

Objetivos: Describir la forma en que se establecen normativamente el consentimiento informado (CI) y las directivas anticipadas (DA) en países latinoamericanos en relación a la asistencia en salud y la investigación, y su análisis desde la bioética. Métodos: Se realizó un análisis comparativo de las normativas vigentes de los 21 países latinoamericanos respecto al CI y las DA. Se confeccionaron reportes de extracción de datos que fueron diseñados antes de iniciar el proceso de investigación para cada país. Se analizaron cualitativamente similitudes y diferencias respecto a variables predefinidas. Se realizaron tablas para sintetizar la información donde fue posible.Resultados:Dieciocho países latinoamericanos prevén una norma específica para el uso del CI en el ámbito clínico. Seis países han incorporado normativas respecto al uso del CI en la virtualidad. Respecto al uso del CI en investigación, 20 países latinoamericanos prevén una norma específica para este ámbito. En el caso de la exposición académica, son 6 países los que nombran esta situación en la normativa. Siete países latinoamericanos cuentan con normativa para establecer DA.Conclusiones:América Latina ha presentado una notable evolución en torno a normar dos de los más importantes instrumentos del ejercicio de la autonomía, como los son el CI y las DA. La legislación sobre ambos instrumentos no garantiza mayor autonomía en salud, pero su existencia como reguladora de acciones para la toma de decisiones constituye el primer paso para su ejercicio.(AU)

Objectius: Descriure la manera com s'estableixen normativament el consentiment informat (CI) i les directives anticipades (DA) en països llatinoamericans en relació amb l'assistència en salut i la investigació, i la seva anàlisi des de la bioètica. Mètodes: Es va realitzar una anàlisi comparativa de les normatives vigents dels 21 països llatinoamericans respecte al CI i les DA. Es van confeccionar reports d’extracció de dades que van ser dissenyats abans d’iniciar el procés de recerca per a cada país. Es van analitzar qualitativament similituds i diferències respecte de variables predefinides. Es van fer taules per sintetitzar la informació on va ser possible.Resultats:Divuit països llatinoamericans preveuen una norma específica per a l'ús del CI a l'àmbit clínic. Sis països han incorporat normatives respecte a l'ús del CI a la virtualitat. Pel que fa a l'ús del CI eninvestigació, 20 països llatinoamericans preveuen una norma específica per a aquest àmbit. En el cas de l'exposició acadèmica, són 6 països els que nomenen aquesta situació a la normativa. Set països llatinoamericans tenen normativa per establir DA.Conclusions:Amèrica Llatina ha presentat una notable evolució al voltant de normar dos dels instruments més importants de l'exercici de l'autonomia, com els són el CI i les DA. La legislació sobre tots dos instruments no garanteix més autonomia en salut, però la seva existència com a reguladora d'accions per a la presa de decisions constitueix el primer pas per al seu exercici.(AU)

Objectives: To describe how informed consent (IC) and living wills (LW) are legally established in Latin American countries in relation to health care and research, and to analyse that from bioethics. Methods: A comparative analysis of the current regulations of the 21 Latin American countries regarding CI and LW was carried out. Data extraction reports were prepared before starting the research process for each country. Similarities and differences were qualitatively analyzed according to predefined variables. Tables were made to synthesize the information where possible.Results:Eighteen Latin American countries provide a specific criteria for IC use in clinical setting. Six countries have incorporated regulations regarding the use of ICin virtually environment. Regarding the use of IC in research, 20 Latin American countries provide a specific regulation. In the case of the academic exposure, 6 countries name this situation in their regulations. Seven Latin American countries have regulations to establish LW.Conclusions:Latin America has presented a notable evolution around regulating two of the most important instruments of the exercise of autonomy, such as the CI and the DA. The legislation on both instruments does not guarantee that there is greater autonomy in health, but its existence as a regulator of actions for decision-making constitutes the first step for its exercise.(AU)

"Not in my name": the anti-racist praxis of Mab Segrest & Minnie Bruce Pratt.

Minnie Bruce Pratt (1946-) and Mab Segrest (1949-) are white middle-class lesbians that both came of age during the classical phase of the Civil Rights Movement in rural Alabama. Today, they are considered influential figures in feminist and lesbian, gay, bisexual, transgender, and queer (LGBTQ) literary movements and recognized as important activists in late twentieth-century feminist, LGBTQ, and anti-racist political struggles. Examining Pratt's Rebellion: Essays, 1980-1991 (1991) and Segrest's Memoir of a Race Traitor (1994), I argue that both texts deconstruct the sociopolitical dynamics and ideologies that inform the inculcation of white middle-class southern womanhood specifically and hegemonic white southern culture generally through performing a form of anti-racist praxis that I call geospatial critique. This term addresses how Pratt and Segrest mine spaces that they occupy for histories of struggle, paying specific attention to how white settler-colonialism and chattel slavery produced particular epistemologies of race, class, gender, and sexuality that continue to influence social identities and practices in the present. Initially developed during Pratt and Segrest's collaboration on Feminary, a lesbian-feminist journal located in Durham, North Carolina, between 1978 and 1982, geospatial critique, I suggest, is a direct response to or a way of undoing the racial training that was part of the production of whiteness in the south from the turn to the first half of the twentieth century.

Sanadores inesperados: medicina china en la era de migración global (Lima y California, 1850-1930) / Unexpected healers: Chinese medicine in the age of global migration (Lima and California, 1850-1930)

Resumen Las masivas olas de migrantes chinos que llegaron a California y Lima en la segunda mitad del siglo XIX jugaron un rol clave en la expansión de la medicina china en ambos contextos. Desde fines de la década de 1860, los herbolarios expandieron su sistema de sanación más allá de su comunidad étnica, transformando la medicina china en una de las prácticas de sanación más adoptada por la población local. Desde una perspectiva comparada, este artículo examina las divergentes trayectorias de los sanadores chinos en Perú y EEUU, así como los factores sociales y políticos que determinaron la adaptación de este conocimiento médico, foráneo, en su nuevo entorno.

Abstract The massive waves of Chinese migrants arriving in California and Lima in the second half of the nineteenth century played a crucial role in expanding Chinese medicine in both settings. From the late 1860s on, herbalists expanded their healing system beyond their ethnic community, transforming Chinese medicine into one of the healing practices most widely adopted by the local population. This article uses a comparative approach to examine the diverging trajectories of Chinese healers in Peru and the USA, as well as the social and political factors that determined how this foreign medical knowledge adapted to its new environments.

Reclamaciones médico-legales y cirugía de varices. Peritajes de un cirujano vascular durante 25 años / Medicolegal claims and varicose vein surgery. Expert reports presented by vascular surgeon over a 25 year period, and literature review

INTRODUCCIÓN: En nuestro país no son bien conocidas las causas que originan reclamaciones judiciales en cirugía vascular. OBJETIVO: Determinar situaciones de riesgo que inducen reclamaciones en cirugía de las varices y proponer recomendaciones para su prevención. MATERIAL Y MÉTODOS: Estudio retrospectivo de la documentación de un cirujano vascular sobre los peritajes por él realizados ante reclamaciones judiciales en angiología y cirugía vascular durante 25 años (1990-2015). Conjuntamente, se efectúa una revisión-análisis de la literatura. RESULTADOS: Se encontró un total de 10 peritajes médico-legales por reclamaciones derivadas de enfermedad vascular, lo que supone 0,40 casos/año (1 cada 3 años). Ocho fueron por enfermedad venosa (80%) y 2 por enfermedad arterial (20%). Del total, 8 fueron complicaciones durante o después de la cirugía (80%), 3 de ellas con resultado de muerte (37,5%). La cirugía de las varices motivó 6 demandas: 2 lesiones nerviosas (nervio ciático y nervio safeno), una por stripping de la arteria femoral superficial y 3 por embolia pulmonar mortal. Según nuestra documentación, ningún dictamen judicial condenó al médico. Un demandante recibió indemnización económica. Otro dictamen condenó a la demandante a pagar las costas del juicio. Esta pequeña serie coincide, en gran parte, con las causas de reclamación señaladas en la literatura. CONCLUSIÓN: Comparada con otras especialidades, la cirugía vascular no presenta un alto volumen de reclamaciones. No obstante, dentro de la cirugía vascular, el tratamiento de las varices supone una parcela de alto riesgo. De forma específica, la prevención de la embolia pulmonar es un aspecto de primer orden para evitar reclamaciones médico-legales

INTRODUCTION: The causes of legal claims in vascular surgery are not very well-known in Spain. OBJECTIVE: To identify risk situations that lead to claims in surgery of varicose veins and propose recommendations for prevention. MATERIALS AND METHODS: Retrospective study documenting the expert reports presented by a vascular surgeon on legal claims in angiology and vascular surgery over a 25 year period (1990-2015). A review and analysis of the literature is also made. RESULTS: There were 10 medico-legal claims arising from vascular pathology expert representing 0.40 cases/year (1 every 3 years). Eight were from venous disease (80%) and 2 arterial disease (20%). Of these, 8 were complications during or after surgery (80%), 3 of them resulting in death (37.5%). Varicose vein surgery led to 6 claims: 2 nerve injury (sciatic nerve and saphenous nerve), one by stripping of the superficial femoral artery, and 3 fatal pulmonary embolism. No court ruling sentenced the doctor. An applicant received financial compensation. In another, the applicant was ordered to pay the court costs. This small series coincides largely with the causes of complaints identified in the literature. CONCLUSION: Compared with other specialties, vascular surgery does not have a high volume of claims. However, in vascular surgery, the treatment of varicose veins has several high risks. Specifically, the prevention of pulmonary embolism, is an aspect of the first order to avoid medico-legal claims

Livestock in biomedical research: history, current status and future prospective.

Livestock models have contributed significantly to biomedical and surgical advances. Their contribution is particularly prominent in the areas of physiology and assisted reproductive technologies, including understanding developmental processes and disorders, from ancient to modern times. Over the past 25 years, biomedical research that traditionally embraced a diverse species approach shifted to a small number of model species (e.g. mice and rats). The initial reasons for focusing the main efforts on the mouse were the availability of murine embryonic stem cells (ESCs) and genome sequence data. This powerful combination allowed for precise manipulation of the mouse genome (knockouts, knockins, transcriptional switches etc.) leading to ground-breaking discoveries on gene functions and regulation, and their role in health and disease. Despite the enormous contribution to biomedical research, mouse models have some major limitations. Their substantial differences compared with humans in body and organ size, lifespan and inbreeding result in pronounced metabolic, physiological and behavioural differences. Comparative studies of strategically chosen domestic species can complement mouse research and yield more rigorous findings. Because genome sequence and gene manipulation tools are now available for farm animals (cattle, pigs, sheep and goats), a larger number of livestock genetically engineered (GE) models will be accessible for biomedical research. This paper discusses the use of cattle, goats, sheep and pigs in biomedical research, provides an overview of transgenic technology in farm animals and highlights some of the beneficial characteristics of large animal models of human disease compared with the mouse. In addition, status and origin of current regulation of GE biomedical models is also reviewed.

Regulação do trabalho médico no Brasil: impactos na Estratégia Saúde da Família / Regulation of medical work in Brazil: impacts on the Family Health Strategy

O artigo apresenta uma revisão da regulação do trabalho dos médicos de família no Brasil e em outros países, com o objetivo de discutir medidas recentes do Ministério da Saúde que flexibilizaram a carga horária de trabalho dos médicos na Estratégia Saúde da Família. A abordagem é feita a partir de uma revisão bibliográfica e da legislação brasileira sobre o tema, numa perspectiva comparada com experiências de outros países. A pesquisa revelou a existência de um padrão de baixa regulação estatal tanto do trabalho médico, quanto de sua formação no Brasil, especialmente no que diz respeito à medicina da família, quando comparada com experiências internacionais. Esta situação resulta numa baixa oferta de profissionais para a Estratégia Saúde da Família e contribuiu para a recente flexibilização da carga horária dos médicos e para a criação do Programa Mais Médicos pelo Ministério da Saúde. A opção pela flexibilização no lugar de maior regulação sobre a profissão pode afetar a integração das equipes de saúde da família, que constitui elemento central da estratégia e aparentemente contradiz a ênfase no papel prioritário da mesma reiteradamente declarada pelo ministério. (AU)

For better or for worse? The dilemmas of unmarried motherhood in mid-twentieth-century popular British film and fiction.

This article investigates representations of unmarried motherhood in the late 1940s and early 1950s through readings of popular British film and fiction. These sources are used to illustrate contradictions and conflicts in the meanings afforded to unmarried motherhood and, in turn, to highlight how the unmarried mother was used as a motif for exploring post-war normative boundaries around marriage, motherhood, and female sexuality. The article draws upon Raymond Williams's idea of a 'structure of feeling' to make connections between these representations and issues and debates about the role and status of women and mothers more generally in post-war Britain.

Sexing Berlin?

Berlin has always been a literary space of extremely diverse political and cultural projections. This essay investigates why after the unification of East and West Berlin the city has been imagined as a play zone of sexual self-fulfilment by authors such as Inka Parei, Tanja Dückers, Kathrin Röggla, Judith Hermann and Julia Franck. Have such erotic adventures replaced political vision in our post-utopian decade? What is the purpose of the laboured allegorisation of the fall of the wall in Durs Grünbein's essays or in the novels of Katja Lange-Müller and Thomas Hettche? The sexification of historical and political processes recalls similar stereotypes in the East German literature of the 1980s: the metropolis as a whore in works by Heiner Müller or Wolf Biermann, but also by younger authors of the independent literary scene in Berlin like Uwe Kolbe or Frank-Wolf Matthies.

Women stereotypes in Shi Zhecun's short stories.

This article analyses the representation of women in two 1933 short story collections by Shi Zhecun: An Evening of Spring Rain and Exemplary Conduct of Virtuous Women. It discusses how the New Woman image was a site of contestation in Republican China, and argues that Shi Zhecun's short stories contain four basic stereotypes: the enigmatic woman, the estranged wife, the prostitute, and the inhibited woman. Using these narratives of women and how they were perceived by men, Shi Zhecun deconstructed the New Woman image by subverting the various ways modernity was projected onto women.

"In those days the distances were all very different": alienation in Ernest Hemingway's "God Rest You Merry, Gentlemen".

This essay explores the significance of the opening paragraph of Hemingway's "God Rest You Merry, Gentlemen," examining the perplexing but necessary comparison of two seemingly unrelated locales, Kansas City and Constantinople. Early drafts of the story include substantively different introductions. In the published story, however, Hemingway's reliance on a barren physical topography establishes the emotional climate, uniting two distant cities to suggest that the impoverishment of modern urban life is the root cause of the story's tragedy.

Between the town and the mountain: abortion and the politics of life in Edith Wharton's "Summer".

In the early twentieth century, American laws focused on women's reproductive capacities and were coalescing into the ethical and moral frameworks that subtend American reproductive politics today. Edith Wharton published her 1917 novel, Summer, at a time when anti-abortion sentiment was widespread in American culture. Through a reading of Summer, the article provides a theoretical and historical framework for understanding this new American obsession with the judicial regulation of women's reproductive options. In particular, I situate the novel's presentation of abortion within the tension between the carefully defined laws of North Dormer, the town in which the majority of the story takes place, and the lawlessness of the Mountain, a place that looms throughout the story as the protagonist's birthplace and a location of utmost abjection. The novel's profound insight is that power does not function unilaterally and individually but through and on the population. Furthermore, Wharton leaps ahead by recognizing that life is not simply that which lives but that which is recognized and embraced by the law. This realization, one that Wharton must have come to terms with through her painful work with World War I refugees, shapes Charity's character and her understanding not only of how reproduction is regulated but also of how living within this regulation and control generates the norm and offers the only possibility for a liveable and legible life.

Seduction, prostitution, and the control of female desire in popular Antebellum fiction.

During the antebellum era, increased attention to the prostitute coincided with a prevalent conception of women as, in Nancy Cott's words, essentially "passionless" unless aroused by sincere romantic love. Yet it seems paradoxical that this ideology existed alongside an increasing awareness of women whose livelihood depended upon manufacturing and marketing sexual desire. In this essay I argue that the prostitute became an object of antebellum fascination and concern less because of her defiance of the ideology of passionlessness and more because of the extent to which she could be made to reinforce this ideology. Casting the prostitute as a victim of seduction preserved predominant beliefs about the dependency of female desire on male impetus. The popular novels of George Thompson and Osgood Bradbury elide the sexual autonomy of the prostitute by making her a victim of men, but they do so in different ways. Thompson employs two variants of the seduction narrative that differ according to class, but both result in the subjection of female desire to male control. His indigent females are chaste victims of violent forms of sexual exploitation, while his licentious rich women reveal an inherent tendency toward monogamy or an inability to command their own aberrant desires. Bradbury, in contrast, is remarkable for his willingness to allow fallen women and prostitutes the chance to reform. As refreshingly progressive as Bradbury's novels seem, however, his adherence to the seduction narrative ultimately suggests that female desire is doomed to dissatisfaction unless properly channeled toward working-class men.

Fatma Aliye's Stories: Ottoman marriages beyond the harem.

The harem image has dominated the conceptualizations of the family and the private sphere in the Ottoman empire at the turn of the century. This essay aims to review these conceptualizations and locate family life in both public and private spheres. The main source of inquiry will be the literary writings of Fatma Aliye (1862-1936) who wrote about women, marriage, education, poverty, and slavery. In these works, she outlined common dreams for Eastern and Western women, such as the love and companionship of an honest, monogamous man. These dreams envisioned Muslim women performing a variety of roles and thus transcended the given expectations from the family and from Muslim women as a monolithic category. In this light, this essay seeks to contextualize Aliye's works within the history of the family by evaluating Aliye's views particularly on marriage.

Killin'em with kindness: "The porter" and Hemingway's racial cauldron.

"The Porter" brings us close to the nightmare plaguing white America's collective imagination during the 20th century's formative years, when white and black collided and racial definition conflated. Hemingway's piece about a young white boy, his father, and the African-American porter who serves them on an overnight train trip is an exploration of 20th century American race relations. Initially, Hemingway pushes the reader to see the world through the young boy's eyes, through the bifurcated lens of racial stereotype. But through the black porter's intervention, the reader comes to recognize that the lens of racial stereotype is imperfect, faulty even, and that notions of white supremacy and the color line are dangerous illusions.