El principio de justicia universal: Fundamentos y limites (Spanish Edition)
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Distributive Justice in Healthcare. Efficiency and Equity. The debate on efficiency needs to address some core issues: the rational and sensible use of drugs, tools, and healthcare technology; the appropriate, inappropriate, or questionable use of diagnostic tests and therapies; the most suitable approach to statements of incapacity to work sick notes regarding duration, harm assessment, vital risk and associated comorbidity; or the waiting-list problem.. The SEC supports decisions that encourage equity, given that healthcare resources are finite.
However, this involves: demonstrating the effectiveness of every action, considering the opportunity cost of diagnostic and therapeutic choices, affirming that the patient's utilities are the most relevant, emphasizing that "optimal is not maximal" or that "more is not always better," and assessing the different categories of care, since not all are equally effective. Medical prescription. The industry's promotional methods. There is a medical obligation to prescribe both rationally and efficiently.
This involves: weighing up its validity, therapeutic usefulness and efficacy, meeting safety criteria, selecting the best option bearing in mind the patient's clinical condition and preferences, obtaining the necessary consent from the patient, and taking into account the economic aspects of the decision, which are sometimes influenced by incentives deriving from external companies or healthcare administrations. The SEC will avoid endorsing promotional campaigns with obvious commercial interests, and will inform the public when messages, or recommendations are disseminated without sufficient scientific evidence, especially if this can generate disproportionate, unjustifiable, or unreal expectations in patients or users, and create distrust towards physicians for not offering them these hypothetical advances.
A framework for agreement: self-criticism, transparency and agreement. The physician has the obligation not to accept any type of gift that decreases, or appears to decrease, the objectivity and impartiality of clinical judgment. All the agents involved need to be brought together and provide the ethical motivation needed to reach an agreement which includes various commitments 20,21,26,, :. These can provide the members of the SEC with useful pointers concerning their activities in daily practice: some concern actual legal obligations with important ethical implications; others relate to moral obligations that must be fulfilled although they are not laws; and finally, some constitute various pieces of sensible advice.
The main aim is to improve quality in the search for professional excellence.. Notify patients of the risks and possible unwanted side-effects of the treatment, strongly urging them to report any unexpected adverse effect should this occur.. This could unjustifiably delay diagnosis or treatment and perhaps expose the patient to inadmissible risk.. Proposals of the Spanish Society of Cardiology. Given its civic commitments, several proposals are set out within the framework of the SEC:.
The education of healthcare professionals should be promoted and encouraged concerning bioethics as well as the socioeconomic aspects and management of healthcare, with the aim of improving their knowledge and skills in decision-making regarding these issues. Attitudes that promote human values in line with authentic medicine aims should be reinforced, especially to prevent the professionals involved becoming demoralized. In this sense, the SEC will promote education and raising awareness in relation to medical ethics..
Committed and collective responsibility should be encouraged in everyone in the socio-healthcare world, regarding both achievements and failures, especially because the public's expectations should not grow beyond the real chances of meeting their demands. In this line, awareness of costs should be gradually introduced:. A deep and transparent political, economic, social, and professional debate should be encouraged regarding:.
Hence, it is neither ethical to forget them nor to be satisfied with less.. The full document includes a large glossary of terms and can be found at www. The SEC would like to publicly thank all of them.. The authors declare that they have not received any financial support, have not experienced any conflicts of interest before, during, or after preparing the document and have carried out the task with full autonomy.. Correspondence: Dr. Facultad de Medicina UCM.
E-mail: mdelosreyes telefonica. Descargar PDF. This document is divided into two distinct parts that deal, respectively, with the responsibilities of the SEC as an organization and the responsibilities of its professional members. The SEC makes recommendations on how its members should carry out their daily clinical practice, provides a professional perspective on public commitments as a scientific association, and aims to ensure that any views, recommendations, and advice expressed provide the basis for an informed debate on ethical problems in our field of work..
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Texto completo. The SEC thus offers itself as a forum. Such members implicitly adopt the official position of the society, although the SEC cannot support all professional actions, especially when in serious conflict with its institutional obligations. Ethical Values and Excellence The ethics of any scientific society or company can no longer focus on merely preparing an ethical code, but should encompass a new moral culture of "convinced and shared responsibility" for the entire organization, especially when developing and applying accreditation systems or quality assessment.
Consistency between what is said, written and done. The obligation to respect confidentiality and privacy in any healthcare relationship, and to protect health data. This exists by virtue of the credibility and good reputation the SEC merits from third parties when offering good service to the public, quality healthcare to patients and quality of life to users, plus continuing education to its members, honest cooperation with companies from the health sector, as well as promoting respect and consideration toward other scientific associations and social institutions.
Autonomy for managing its resources. Providing intelligible and rigorous information on health, as well as supplying the mass media with scientific reports free of bias or deception. Respecting and promoting human rights without discrimination regarding any type of condition, or social or personal circumstance. Open and participatory attitude toward its members, other health professionals and the public, official bodies, associations and organizations, in the search for agreement. This cooperative responsibility, based on justice and solidarity, involves the ability to respond to the health needs and expectations of the community which, in the context of globalization, goes beyond our borders.
Applying efficiency and equity criteria to action within the framework of the Spanish National Health System. Complying with the law and current regulations, without impinging on ethical obligations. Conflicts of Interest The SEC has articulated and maintained a strict code of conduct regarding its own institutional relationships, which are in line with the guidelines of professional associations, 8,9 and regulatory bodies in Spain, in addition to following the guidelines provided by reputable scientific societies.
La lucha contra la discriminación y el acceso a la justicia. Un camino hacia la integración
The scientific program of the Congress is divided into two types of educational activity: an official program round tables, debates on controversial issues, lectures, continuing education, special issues, workshops and an unofficial program industry-sponsored round tables. The Lines of Conduct Governing the Spanish Society of Cardiology The SEC organizes its annual Congress based on high ethical standards and content, which means that sponsorship and the accreditation of educational activities is strictly regulated.
Scope of Relationships Pharmaceutical industry, health technology companies, and others. The SEC will maintain relationships with the Ministry of Education and Culture, central, and regional Administrations and universities to study and develop the academic potential of Spanish cardiologists in graduate and post-gradate teaching. Research is one of the key areas fostered and promoted by the SEC, which necessarily involves increasing collaboration with Spanish and international scientific institutions at the highest level and becoming involved in several RDI research-development-innovation networks.
The SEC will maintain and expand its relationships with all the Spanish scientific societies it considers relevant and with suitable international societies related to its specialty or related sciences. Scientific Publications A Fundamental Aim of the Spanish Society of Cardiology The SEC is responsible for distributing scientific information relevant to its field, through continuing education and all possible media of communication. These represent the official position of the SEC on a specific subject, following the necessary deliberations.
They are created both by members of the Society and others and do not express the official position of the SEC.
This relates to the physician's competence and is defined by lex artis and criteria for indication, non-indication, and contraindication. This relates to the capacity to make decisions and deal with factors related to our own life and death. The term "distributive justice" is used when referring to healthcare resources. Similarly, there should be no double standards whereby objections are raised in the public arena but not in the private one, due to profit motives, privileges, or any other unjustifiable circumstance.
Legal Framework for Professional Practice Assessing medical liability. In order to delimit responsibilities within the team, two principles have been put forward 93 : trust, since a person who acts correctly should trust that the other will also do so; and division of tasks, which results from specialization and scientific progress.
The relationships between physicians and nurses have two dimensions: vertical, involving supraordinate, and subordinate relationships; and horizontal, involving the essential skills exclusive to nursing. The Physician and the Clinical Relationship Information and Consent are Ethical and Legal Issues The clinical relationship between health professionals and patients or users has changed due to the legal recognition of the moral autonomy of people to make decisions regarding their own life, health, and body.
Printed Forms The process of informed consent should not be reduced to a signature on the printed form; rather, this should serve to support previous dialogue. The Physician As Expert Witness The first body to address ethical problems in healthcare institutions are the healthcare ethics committees, which are advisory and multidisciplinary. The debate on efficiency needs to address some core issues: the rational and sensible use of drugs, tools, and healthcare technology; the appropriate, inappropriate, or questionable use of diagnostic tests and therapies; the most suitable approach to statements of incapacity to work sick notes regarding duration, harm assessment, vital risk and associated comorbidity; or the waiting-list problem.
The main aim is to improve quality in the search for professional excellence. Notify patients of the risks and possible unwanted side-effects of the treatment, strongly urging them to report any unexpected adverse effect should this occur. This could unjustifiably delay diagnosis or treatment and perhaps expose the patient to inadmissible risk. Proposals of the Spanish Society of Cardiology Given its civic commitments, several proposals are set out within the framework of the SEC: 1.
In this sense, the SEC will promote education and raising awareness in relation to medical ethics. Hence, it is neither ethical to forget them nor to be satisfied with less. The SEC would like to publicly thank all of them. The authors declare that they have not received any financial support, have not experienced any conflicts of interest before, during, or after preparing the document and have carried out the task with full autonomy.
Estatutos y Reglamento.
Madrid: SEC; Medical ethics in the era of managed care: the need for institutional structures instead of principles for individual cases.. J Clin Ethics, 6 , pp. En: Cortina A, editor. Construir confianza. Madrid: Trotta; En: Sim?? Nuevos modelos de calidad. Madrid: Asociaci?? Rev Calidad Asistencial, 18 , pp. En: Lolas F, editor. Equidad, calidad, derechos. Santiago de Chile: Programa Regional de Bio??
Madrid: Consejo General de Colegios de M?? Barcelona: Consell de Col?? J Am Coll Cardiol, 16 , pp.
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J Am Coll Cardiol, 31 , pp. Circulation, , pp. Ann Intern Med. The BMA's handbook of ethics and law. BMJ; Disponible en: http. Disponible en: www. Understanding financial conflicts of interest.. N Engl J Med, , pp. Tiempo para las luces y los taqu?? Gac Sanit, 14 , pp. Med Clin Barc , , pp.
Madrid: OMC; Physician-Industry Relations. Part 2: Organizational Issues.. Ann Intern Med, , pp. Barcelona: Fundaci?? Se puede confiar en los resultados de la investigaci??
Humanitas, Humanidades M?? Part 1: Individual Physicians.. BM, , pp. Int J Pharm Med, 12 , pp. Normas generales. Disponible en: soc secardiologia. Rev Esp Cardiol, 57 , pp. Who's the author? Problems with biomedical authorship, and some possible solutions.. Science Editor, 23 , pp. Rev Esp Cardiol, 54 , pp. Conflict of interest.
The new McCarthyism in Science.. J Am Med Assoc, , pp. Este lo hace usando la fuerza soberana de la cual es depositario. En ella reside el poder legislativo, cuya tarea es dictar la ley declarar la voluntad general. La asamblea legislativa puede darse la forma de gobierno que estime adecuada.
En efecto:. El todo puede analizarse destacando distintos aspectos de su complejidad. Con ello se pone de relieve la naturaleza del acto constitutivo y a la naturaleza de los individuos que se asocian. El equilibrio del todo depende del equilibrio que guarden las relaciones entre sus partes. Estas condiciones favorecen el logro del equilibrio igualdad en las relaciones entre las partes y, por ende, del mismo todo. En esta perspectiva:. En general, ello puede ser resultado i del juego de los intereses particulares, que son propios de la naturaleza de los hombres.
Por otra parte ii dicho juego puede verse favorecido por la forma de gobierno que se establece. Veamos brevemente en que consiste. Bergeron, G. Logique Juridique, Paris. Bloom, A. Strauss y J. Cropsey, comps. Gallimard, Paris. Derrida, J. Tamarit Sumalla, Josep Maria Overview. Publication Timeline. Most widely held works by Josep Maria Tamarit Sumalla. Historical memory and criminal justice in Spain : a case of late transitional justice by Josep Maria Tamarit Sumalla Book 10 editions published in in English and held by 95 WorldCat member libraries worldwide The Spanish transition from the Franco regime to democracy has not been a very popular subject amongst researchers examining transitional justice at the international level.
However, Spain presents certain peculiarities that make it an interesting case in which to explore comparative law and sociology. It has sometimes been seen as a model of peaceful transition, but has also been labelled as an example of an "amnesic" transition to a democratic system in which victims' rights, justice and truth were forgotten. In contrast to other transitions, demands of justice were not expressed during what was the purely transitional period, but they have been on the increase since then.