Revista chilena de obstetricia y ginecología, May 22, 2023
Operación cesárea a requerimiento materno. Análisis de la circular N.º 10 del Ministerio de Salud... more Operación cesárea a requerimiento materno. Análisis de la circular N.º 10 del Ministerio de Salud y una propuesta alternativa Specifically on the so-called cesarean section on maternal request. An analysis of circular Nº 10 of the Ministry of Health and an alternative proposal
One observed case of verrucous carcinoma involving the uterine cervix is presented. Both clinical... more One observed case of verrucous carcinoma involving the uterine cervix is presented. Both clinical and pathologic aspects, and pertinent literature are discussed.
Une enquete serologique est effectuee par le test d'inhibition de l'hemagglutination chez... more Une enquete serologique est effectuee par le test d'inhibition de l'hemagglutination chez 1064 donneurs de sang et chez 1000 meres et 1011 nouveau-nes. Le test est positif chez 2,5% des donneurs de sang et 1,7% des meres et 1,3% des nouveau-nes
We studied 45 patients with fetal malpresentations in a controlled trial, in which external cepha... more We studied 45 patients with fetal malpresentations in a controlled trial, in which external cephalic version with tocolysis was performed. The final version rate was 73%, with a 49% of cesarean section in the study group compared with 87% in the control group. The most important factors related with successful version were type of presentation and parity. No important maternal of fetal complications were noted.
Six transabdominal cerclages in patients with cervical incompetence due to severe cervix damage o... more Six transabdominal cerclages in patients with cervical incompetence due to severe cervix damage or vaginal cerclage failure are presented. Results are discussed. In this series the salvage rate was 90%. For the first time in the literature a successful case of transabdominal cerclage in patient with a cervico-vaginal fistula is presented.
The question about the identification of the exact moment when human life begins has a special et... more The question about the identification of the exact moment when human life begins has a special ethic transcendence. Elements afforded by science are insufficient for this objective, because of the nature of the object in study and of the cognoscent subject. This article makes a proposal with arguments afforded by the philosophical reflection.
tramos recursos o debemos tratar con personal a nuestro cargo, lo que no es sólo inevitable sino ... more tramos recursos o debemos tratar con personal a nuestro cargo, lo que no es sólo inevitable sino que es considerado parte importante de nuestra labor profe-sional. El problema se presenta cuando por iniciativa personal, por petición o por de-manda de tipo laboral, nos vemos en-frentados a una actividad profesional en la cual percibimos que entramos en al-gún tipo de conflicto con los intereses primarios de nuestra profesión. La situación del médico a este respec-to es emblemática. La Sociedad no sólo necesita médicos que se dediquen a pre-venir y sanar enfermedades, sino que parece necesitar a médicos que solucio-nen diversos otros problemas en los cua-les la prevención y curación de enferme-dades tienen poca o ninguna relación. De esta manera, es ya habitual ver a médi-cos desempeñando labores diversas y quizás no por eso menos importantes para nuestra organización social, como la investigación científica o los peritajes para compañías de seguros. Existen numerosas y variadas labor...
Ethical arguments for and against the participation of the medical profession in assisted death: ... more Ethical arguments for and against the participation of the medical profession in assisted death: analysis of the Ethics Department of the Chilean Medical Association The discussion of a bill that allows medically assisted death (MAD) in Chile, revived the debate about the ethics of this practice. The Department of Ethics of the Chilean Medical Association herein analyzes arguments in favor or against the participation of the medical profession in MAD. Among the main arguments against the participation of physicians in this practice are that MAD conflicts with the basic ethical principles of medical practice, that it is contrary to the purposes of medicine and that it could erode the patients' and society's confidence in physicians. The arguments in favor are related to physician´s compassion and non-abandonment of patients during their illness, choosing palliative care and ushering them to the final instance. Additionally, there is social expectation that this practice will be carried out by trained physicians who can verify that the strict criteria established by the legislation are met, guarantee that it obeys to a repeated request of a fully capable patient, and who is able to deal with the complications of the procedure. In this document we aimed to represent the different perspectives about physicians' participation in MAD, offering arguments to colleagues and stimulating their participation in this important debate.
Ethics code of the medical college of Chile. Critical analysis of a modification The code of ethi... more Ethics code of the medical college of Chile. Critical analysis of a modification The code of ethics of the Medical College of Chile was modified in December 2019. The amendment was mainly to article 8, which refers to the doctor's duty to care for the pregnant woman and the child she is carrying. The change maintains this duty, but allows doctors to perform abortions, introducing three considerations that act as new principles or values for the medical profession: the plurality of values existing in society, the autonomy of women and what is established by law. This paper is a reflection on codes of ethics, their relationship with values, and with legislation. Also it shows the consequences that this modification represents for the principles governing medical activity, the status of medical specialties, the commitment of doctors to their patients and the validity of the code of ethics.
Every so often, in Chile there is a discussion about the role of physicians in the care of people... more Every so often, in Chile there is a discussion about the role of physicians in the care of people on hunger strike (HS). In this document, we review the ethical aspects of health care for persons in HS, aiming to provide guidelines to medical doctors who are required to attend them. First, we make an important distinction between HS and suicide, since the former is used as a protest and denunciation tool, while suicide seeks deliberately to end a life. Then we describe the three roles that the health professional can fulfill: as a treating doctor, as an expert or as an official of a prison. The respect for the autonomy and dignity of the person in HS must prevail whatever the role of the physician. Therefore, we maintain that under no circumstances, people who have autonomously decided to be in HS should be fed by force. Due to the complexity of the issue, we make special considerations about the management of minors and the non-competent persons in HS. In conclusion, we adhere to the principles that inspire the Declaration of Malta, which indicate that it would be preferable to "allow a person on hunger strike to die in dignity, rather than subjecting them to repeated interventions against their will".
El presente artículo corresponde a un archivo originalmente publicado en Ars Medica, revista de e... more El presente artículo corresponde a un archivo originalmente publicado en Ars Medica, revista de estudios médicos humanísticos, actualmente incluido en el historial de Ars Medica Revista de ciencias médicas. El contenido del presente artículo, no necesariamente representa la actual línea editorial. Para mayor información visitar el siguiente vínculo:
Conscientious objection and the values of medical profession It is usual to understand conscienti... more Conscientious objection and the values of medical profession It is usual to understand conscientious objection as a doctor's refusal to perform a legitimate intervention, for subjective personal reasons unrelated to medicine. It is then accepted only by respect to professional autonomy and freedom of beliefs. Understood in that way it would be thus reasonable to limit it, curtail it or delete it, since the objector would not be willing to grant benefits that correspond to his medical profession. This work aims to show exactly the opposite, taking as an example the project of law that pretends to decriminalize abortion in some situations in Chile. Is the objector who defends medical activity relying on ethic codes that seek to preserve the values and principles of our profession.
Revista chilena de obstetricia y ginecología, May 22, 2023
Operación cesárea a requerimiento materno. Análisis de la circular N.º 10 del Ministerio de Salud... more Operación cesárea a requerimiento materno. Análisis de la circular N.º 10 del Ministerio de Salud y una propuesta alternativa Specifically on the so-called cesarean section on maternal request. An analysis of circular Nº 10 of the Ministry of Health and an alternative proposal
One observed case of verrucous carcinoma involving the uterine cervix is presented. Both clinical... more One observed case of verrucous carcinoma involving the uterine cervix is presented. Both clinical and pathologic aspects, and pertinent literature are discussed.
Une enquete serologique est effectuee par le test d'inhibition de l'hemagglutination chez... more Une enquete serologique est effectuee par le test d'inhibition de l'hemagglutination chez 1064 donneurs de sang et chez 1000 meres et 1011 nouveau-nes. Le test est positif chez 2,5% des donneurs de sang et 1,7% des meres et 1,3% des nouveau-nes
We studied 45 patients with fetal malpresentations in a controlled trial, in which external cepha... more We studied 45 patients with fetal malpresentations in a controlled trial, in which external cephalic version with tocolysis was performed. The final version rate was 73%, with a 49% of cesarean section in the study group compared with 87% in the control group. The most important factors related with successful version were type of presentation and parity. No important maternal of fetal complications were noted.
Six transabdominal cerclages in patients with cervical incompetence due to severe cervix damage o... more Six transabdominal cerclages in patients with cervical incompetence due to severe cervix damage or vaginal cerclage failure are presented. Results are discussed. In this series the salvage rate was 90%. For the first time in the literature a successful case of transabdominal cerclage in patient with a cervico-vaginal fistula is presented.
The question about the identification of the exact moment when human life begins has a special et... more The question about the identification of the exact moment when human life begins has a special ethic transcendence. Elements afforded by science are insufficient for this objective, because of the nature of the object in study and of the cognoscent subject. This article makes a proposal with arguments afforded by the philosophical reflection.
tramos recursos o debemos tratar con personal a nuestro cargo, lo que no es sólo inevitable sino ... more tramos recursos o debemos tratar con personal a nuestro cargo, lo que no es sólo inevitable sino que es considerado parte importante de nuestra labor profe-sional. El problema se presenta cuando por iniciativa personal, por petición o por de-manda de tipo laboral, nos vemos en-frentados a una actividad profesional en la cual percibimos que entramos en al-gún tipo de conflicto con los intereses primarios de nuestra profesión. La situación del médico a este respec-to es emblemática. La Sociedad no sólo necesita médicos que se dediquen a pre-venir y sanar enfermedades, sino que parece necesitar a médicos que solucio-nen diversos otros problemas en los cua-les la prevención y curación de enferme-dades tienen poca o ninguna relación. De esta manera, es ya habitual ver a médi-cos desempeñando labores diversas y quizás no por eso menos importantes para nuestra organización social, como la investigación científica o los peritajes para compañías de seguros. Existen numerosas y variadas labor...
Ethical arguments for and against the participation of the medical profession in assisted death: ... more Ethical arguments for and against the participation of the medical profession in assisted death: analysis of the Ethics Department of the Chilean Medical Association The discussion of a bill that allows medically assisted death (MAD) in Chile, revived the debate about the ethics of this practice. The Department of Ethics of the Chilean Medical Association herein analyzes arguments in favor or against the participation of the medical profession in MAD. Among the main arguments against the participation of physicians in this practice are that MAD conflicts with the basic ethical principles of medical practice, that it is contrary to the purposes of medicine and that it could erode the patients' and society's confidence in physicians. The arguments in favor are related to physician´s compassion and non-abandonment of patients during their illness, choosing palliative care and ushering them to the final instance. Additionally, there is social expectation that this practice will be carried out by trained physicians who can verify that the strict criteria established by the legislation are met, guarantee that it obeys to a repeated request of a fully capable patient, and who is able to deal with the complications of the procedure. In this document we aimed to represent the different perspectives about physicians' participation in MAD, offering arguments to colleagues and stimulating their participation in this important debate.
Ethics code of the medical college of Chile. Critical analysis of a modification The code of ethi... more Ethics code of the medical college of Chile. Critical analysis of a modification The code of ethics of the Medical College of Chile was modified in December 2019. The amendment was mainly to article 8, which refers to the doctor's duty to care for the pregnant woman and the child she is carrying. The change maintains this duty, but allows doctors to perform abortions, introducing three considerations that act as new principles or values for the medical profession: the plurality of values existing in society, the autonomy of women and what is established by law. This paper is a reflection on codes of ethics, their relationship with values, and with legislation. Also it shows the consequences that this modification represents for the principles governing medical activity, the status of medical specialties, the commitment of doctors to their patients and the validity of the code of ethics.
Every so often, in Chile there is a discussion about the role of physicians in the care of people... more Every so often, in Chile there is a discussion about the role of physicians in the care of people on hunger strike (HS). In this document, we review the ethical aspects of health care for persons in HS, aiming to provide guidelines to medical doctors who are required to attend them. First, we make an important distinction between HS and suicide, since the former is used as a protest and denunciation tool, while suicide seeks deliberately to end a life. Then we describe the three roles that the health professional can fulfill: as a treating doctor, as an expert or as an official of a prison. The respect for the autonomy and dignity of the person in HS must prevail whatever the role of the physician. Therefore, we maintain that under no circumstances, people who have autonomously decided to be in HS should be fed by force. Due to the complexity of the issue, we make special considerations about the management of minors and the non-competent persons in HS. In conclusion, we adhere to the principles that inspire the Declaration of Malta, which indicate that it would be preferable to "allow a person on hunger strike to die in dignity, rather than subjecting them to repeated interventions against their will".
El presente artículo corresponde a un archivo originalmente publicado en Ars Medica, revista de e... more El presente artículo corresponde a un archivo originalmente publicado en Ars Medica, revista de estudios médicos humanísticos, actualmente incluido en el historial de Ars Medica Revista de ciencias médicas. El contenido del presente artículo, no necesariamente representa la actual línea editorial. Para mayor información visitar el siguiente vínculo:
Conscientious objection and the values of medical profession It is usual to understand conscienti... more Conscientious objection and the values of medical profession It is usual to understand conscientious objection as a doctor's refusal to perform a legitimate intervention, for subjective personal reasons unrelated to medicine. It is then accepted only by respect to professional autonomy and freedom of beliefs. Understood in that way it would be thus reasonable to limit it, curtail it or delete it, since the objector would not be willing to grant benefits that correspond to his medical profession. This work aims to show exactly the opposite, taking as an example the project of law that pretends to decriminalize abortion in some situations in Chile. Is the objector who defends medical activity relying on ethic codes that seek to preserve the values and principles of our profession.
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