Publication: Ética de los problemas en el ejercicio médico de la dermatología en Castilla-La Mancha
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2017-10-03
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Universidad Complutense de Madrid
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Abstract
A lo largo del Siglo XX se va perfilando una nueva ética de la profesión médica. Será en su segunda mitad cuando, fruto de los avatares históricos, la evolución de la ciencia médica y de la sociedad en general, se vaya imponiendo en EE.UU., a golpe de sentencias judiciales, una nueva forma de entender la relación médico paciente sustentada en el respeto a la libertad individual de las personas. Esto llevará a que haga crisis el paradigma ético clásico de la profesión médica y aflore un nuevo paradigma que, lejos del paternalismo que había sustentado aquel, apoye sus fundamentos en el respeto a la libertad del paciente a la hora de decidir que quiere hacer con su cuerpo y su salud. Este respeto a la autonomía no será único sino que estará encuadrado en un contexto de principios a respetar por todos. En el último tercio del siglo se irá imponiendo esta tendencia en los países europeos. En España, al socaire del nuevo régimen político que se abre camino con las elecciones democráticas a Cortes Generales Constituyentes de la nación, que alumbrarán la Constitución Española de 1978, se irá abriendo paso ese nuevo paradigma llegando a sustanciarse en normativa deontológica en el Primer Código de Ética y Deontología Médica. A éste Código le seguirán otros. Las leyes que regulan el ejercicio profesional médico irán gestionándose en el mismo sentido, alcanzando su cenit con la aprobación del, comúnmente denominado, Convenio de Oviedo. Adecuadas las leyes y las normas deontológicas a ese nuevo paradigma, asumido éste por las organizaciones profesionales y la sociedad en general, falta saber si los médicos lo han asumido y guían su actuación clínica conforme a sus postulados. Nuestro trabajo se ha ceñido, desde las premisas arriba expuestas y limitado territorialmente a la Comunidad de Castilla-La Mancha, a conocer si el ejercicio profesional de la Dermatología Clínica asienta sus postulados éticos en el respeto a la intimidad, el derecho a la información y el respeto a la libre decisión del paciente o de quien legalmente le represente. En definitiva queremos saber si, cambiadas las leyes, cambiados los preceptos deontológicos y asumido por la sociedad este nuevo modelo de relación horizontal, de decisiones compartidas, los profesionales titulados que practican la dermatología clínica en nuestra comunidad encuadran sus actos en el marco de este nuevo paradigma o, por el contrario, siguen anclados en el paternalismo histórico clásico. OBJETIVOS Con la intención y el deseo puestos de manifiesto en la introducción nos marcamos en este trabajo los siguientes objetivos: 1º.-Conocer la formación y los conocimientos en ética médica, deontología y principales leyes reguladoras del ejercicio profesional de los médicos dermatólogos en ejercicio en el territorio de la Comunidad Autónoma de Castilla-La Mancha. 2º.-Conocer las principales preocupaciones éticas de la población referida. 3º.-Conocer su actitud ética. 4º.-Conocer la respuesta que dan a los problemas éticos que se les plantean en el ejercicio de su actividad diaria...
The twentieth century saw the gradual emergence of new ethics in the medical profession. As a result of historical processes, the evolution of medical sciences and society at large from the 1950s onwards, a series of US court decisions gave way to a redefined understanding of the doctor-patient relationship based on the respect for people’s individual freedom. The subsequent crisis in the classical ethical paradigms of the medical profession has led to a new set of paradigms, which, leaving paternalism behind, is founded upon the respect for the patients’ freedom to make their own decisions concerning their body and health. This respect for autonomy has been included in a framework to be respected by all. However, it was not until the last third of the twentieth century that this trend began to be implemented in the medical practice of European countries. In Spain, under the protection of the new political system that held the first democratic elections for the Cortes Generales [Spain’s parliament] and drafted the Spanish Constitution of 1978, this new paradigm was introduced among the deontological regulations in the Primer Código de Ética y Deontología Médica [First Code of Ethics and Medical Deontology], later to be followed by other codes. The laws regulating professional medical practice also showed similar tendencies and by passing what is commoly referred to as the Oviedo Convention, the paradigm reached full approval. Now that legislation and deontology have adopted it and professional organizations and society at large have assumed it, what is left to know if doctors have accepted it and let their clinical practice be shaped by it. Based on these foundations, the present research project, geographically limiting itself to the autonomous community of Castilla -La Mancha, Spain, sets out to study whether the professional practice of clinical dermatology incorporates the abovementioned ethical principles regarding privacy, the right to information and the patients’ or their legal representatives’ free decision. The study explores whether the changes on the level of legislation and deontological precepts, which are assumed by society and result in a new model of horizontal relationship and shared decision-making, have a real effect on the ways professionals in the field of clinical dermatology act, or they continue to recur to the classical patterns of historical paternalism. OBJECTIVES Following the guidelines explained in the introductory notes, the following objectives are set for this research project: To study the training and knowledge of deontology, deontology and legislation governing the practice of dermatologists working within the territory of the autonomous community of Castilla -La Mancha. To study the main ethical concerns and problems expressed by the population in question. To study their ethical attitudes. To study their answers given to the concerns and problems surfacing in their daily activities...
The twentieth century saw the gradual emergence of new ethics in the medical profession. As a result of historical processes, the evolution of medical sciences and society at large from the 1950s onwards, a series of US court decisions gave way to a redefined understanding of the doctor-patient relationship based on the respect for people’s individual freedom. The subsequent crisis in the classical ethical paradigms of the medical profession has led to a new set of paradigms, which, leaving paternalism behind, is founded upon the respect for the patients’ freedom to make their own decisions concerning their body and health. This respect for autonomy has been included in a framework to be respected by all. However, it was not until the last third of the twentieth century that this trend began to be implemented in the medical practice of European countries. In Spain, under the protection of the new political system that held the first democratic elections for the Cortes Generales [Spain’s parliament] and drafted the Spanish Constitution of 1978, this new paradigm was introduced among the deontological regulations in the Primer Código de Ética y Deontología Médica [First Code of Ethics and Medical Deontology], later to be followed by other codes. The laws regulating professional medical practice also showed similar tendencies and by passing what is commoly referred to as the Oviedo Convention, the paradigm reached full approval. Now that legislation and deontology have adopted it and professional organizations and society at large have assumed it, what is left to know if doctors have accepted it and let their clinical practice be shaped by it. Based on these foundations, the present research project, geographically limiting itself to the autonomous community of Castilla -La Mancha, Spain, sets out to study whether the professional practice of clinical dermatology incorporates the abovementioned ethical principles regarding privacy, the right to information and the patients’ or their legal representatives’ free decision. The study explores whether the changes on the level of legislation and deontological precepts, which are assumed by society and result in a new model of horizontal relationship and shared decision-making, have a real effect on the ways professionals in the field of clinical dermatology act, or they continue to recur to the classical patterns of historical paternalism. OBJECTIVES Following the guidelines explained in the introductory notes, the following objectives are set for this research project: To study the training and knowledge of deontology, deontology and legislation governing the practice of dermatologists working within the territory of the autonomous community of Castilla -La Mancha. To study the main ethical concerns and problems expressed by the population in question. To study their ethical attitudes. To study their answers given to the concerns and problems surfacing in their daily activities...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 03/02/2016