Browsing by Author "Beca, Juan Pablo"
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Item Análisis de una experiencia de consultoría ético clínica en cuidado intensivo(2010) Beca, Juan Pablo; Delgado, Iris; Solar, Sebastián; KOPPMANN A, ALEJANDRO; CHÁVEZ, PAMELASon muy pocos los pacientes que se presentan a los comités de ética, y las consultas éticas individuales son una respuesta a esta situación. En la unidad de cuidados intensivos (UCI) de Clínica Alemana, Santiago de Chile, se organizó un sistema de consulta de ética coordinado con el comité de ética. Objetivo: Informar una evaluación de este sistema de consulta ética. Material y métodos: Análisis de los primeros 50 casos analizados en el sistema de consulta. Análisis de las respuestas de los médicos de cuidados intensivos a un cuestionario sobre los principales problemas éticos a los que se enfrentan en su trabajo. Resultados:El sistema de consulta es requerido principalmente por el personal de la UCI y reporta al comité de ética. El 54% de los pacientes consultados tenían más de 80 años. Los principales diagnósticos fueron problemas neurológicos, oncológicos o cardiopulmonares. Los problemas éticos identifcados fueron limitación del tratamiento (62%), proporcionalidad o futilidad (42%), necesidad de una muerte pacífica (36%), falta de decisiones anticipadas (28%), desacuerdo entre médicos y familiares del paciente (24 %), subrogación indefinida (14%) y abuso de recursos públicos (14%). Veintiséis de los 31 médicos de la UCI respondieron el cuestionario, utilizando una escala de 1 (mínimo) a 7 (máximo). Descubrieron que la consulta es útil para la toma de decisiones (6,3), útil para mejorar la percepción ética (6,0), de apoyo para el personal (6,5), buena para los pacientes (6,3), de apoyo para las familias (6,7),Conclusiones: Como complemento al trabajo del comité de ética, la consulta es una alternativa válida para el asesoramiento ético y un apoyo para los médicos y familiares de los pacientes. Su implementación depende de las particularidades de cada institución de salud.Item UN ANÁLISIS DEL PROBLEMA ÉTICO Y LEGAL DEL TRATAMIENTO DEL CÁNCER CERVICOUTERINO EN MUJERES EMBARAZADAS(2010) Beca, Juan Pablo; González, Marcelo; Mewes, Ricardo; Urquiza, Mikel; Urra, AlejandraSe analiza el problema ético y jurídico del tratamiento del cáncer cervicouterino en mujeres embarazadas. Se realizó una revisión del tema, de las leyes chilenas y de algunas normativas europeas para después analizar la aplicación de los principios de No Maleficencia, Beneficencia, Autonomía y del Doble Efecto. El tema genera una difícil discusión e interpretación, pues tanto las leyes como los principios son orientadores, pero no explícitos para decidir la conducta más adecuada en cada caso. Lo ideal es preservar la vida materna y fetal, pero hay casos en los que, finalmente, es necesario priorizar una sobre la otra. Corresponde al equipo tratante, la madre, el padre, la familia y la sociedad concordar las conductas más responsables y justas posiblesItem Aspectos médicos, éticos y legales de la criopreservación de embriones humanos(Sociedad Médica de Santiago, 2014) Beca, Juan Pablo; Lecaros, Juan Alberto; Gonzalez, Patricio; Sanhueza, Pablo; Mandakovic, BorislavaEmbryo cryopreservation improves efficiency and security of assisted reproduction techniques. Nonetheless, it can be questionable, so it must be justified from technical, legal and ethical points of view. This article analyses these perspectives. Embryo cryopreservation maximizes the probability of pregnancy, avoids new ovary stimulations and reduces the occurrence of multiple gestations. There is consensus that the in vitro embryo deserves legal protection by its own, although not as a newborn. Very few countries prohibit embryo cryopreservation based on the legal duty to protect human life since fecundation. Those countries that allow it, privilege women’s reproductive rights. In Chile and in Latin America, no laws have been promulgated to regulate human assisted reproduction. The moral status of the embryo depends on how it is considered. Some believe it is a potential person while others think it is just a group of cells, but all recognize that it requires some kind of respect and protection. There is lack of information about the number of frozen embryos and their final destination. As a conclusion the authors propose that women or couples should have the right to decide autonomously, while institutions ought to be clear in their regulations. And the legislation must establish the legal status of the embryo before its implantation, the couples’ rights and the regulation of the embryo cryopreservation. Personal, institutional or legal decisions must assume a concept about the moral status of the human embryo and try to avoid their destruction or indefinite storage.Item Item Capacitación básica en Bioética clínica y de investigación a Profesionales del Hospital Policial del Uruguay(Universidad del Desarrollo. Facultad de Medicina, 2024) Heuhs Texeira, Luis Carlos; Beca, Juan PabloItem Criterios de médicos tratantes de pacientes con demencia avanzada para indicar instalación de gastrostomía percutánea(Universidad del Desarrollo. Facultad de Medicina. Centro de Bioética, 2014-10) Portales, María Bernardita; Beca, Juan PabloItem Deactivating Cardiac Pacemakers and Implantable Cardioverter Defibrillators in Terminally Ill Patients(2009) Beca, Juan Pablo; Rosselot, Eduardo; Asenjo, René; Anguita, Verónica; Quevedo, RafaelA 68-year-old patient who suffered from gastric cancer diagnosed 8 months earlier presented with multiple peritoneal and hepatic metastasis, despite several rounds of chemo- and radiotherapy. After admission to hospital, his general condition quickly became severely compromised. He was nearly emaciated, despite being on partial parenteral feeding. Four years earlier, due to a cardiac arrhythmia that was refractory to medication, the patient had a cardiac pacemaker (CPM) implanted, regulated to go off at frequencies of below 70 beats per minute. Given the patient's terminal situation, the team started developing some doubts about the pacemaker's effects during his dying process. The patient had mentioned his intention to donate his pacemaker after his death, but had not asked for its deactivation. The specialists were not sure about the effect of the pacemaker in unnecessarily prolonging the patient's final hour. Nevertheless, they opposed deactivation, which they considered ethically uncertain. The family, who had been initially for the deactivation, decided against it. The patient's condition was progressively deteriorating, as he was falling into a state of sopor and, later, into a comaItem Diez mitos sobre el retiro de la ventilación mecánica en enfermos terminales(2010) Beca, Juan Pablo; Montes, José Miguel; Abarca, JuanThe most difficult of treatment limitation decisions, both for physicians and families, is the withdrawal of mechanical ventilation (MV). Many fears and uncertainties appear in this decision. They are described as “ten myths” whose falseness is argued in this article. The myths are: 1) Withdrawing MV causes the patient’s death; 2) Withdrawing MV is euthanasia; 3) Withholding and withdrawing MV are morally different; 4) MV can be withdrawn only when the patient has asked for it; 5) Chilean law only authorizes to withdraw VM when brain death has occurred; 6) Withdrawing MV cannot be done if the patient is not an organ donor; 7) Physicians who withdraw MV are in high risk of legal claims; 8) To withdraw MV the physician needs an authorization from the hospital ethics committee, lawyer or institutional authority; 9) There is only one way to withdraw MV; 10) Withdrawing MV produces great suffering to the patient’s family. Making clear that these myths are false facilitates appropriate decisions, therefore preventing “therapeutic obstinacy” and more suffering of terminally ill patients, which favors their peaceful death. For the physician this goal should be as rewarding as preventing the death of a curable patientItem Do not resuscitate orders for pediatric patients: The role of a clinical ethics committee in a developing country(1996) Beca, Juan Pablo; Guerrero, José LuisItem Donación y trasplante de órganos: propuesta desde la Academia Chilena de Medicina(2020) Hepp, Juan; Beca, Juan Pablo; Moran, Sergio; Roessler, Emilio; Uribe, Mario; Palacios, José ManuelThe Chilean Academy of Medicine designated a group of specialists to evaluate the practice and to propose reforms for organ donation and transplantation, due to the general insufficiencies at the national level with these procedures. In the last six years the mean number of organ transplants in Chile was 340 cases per year while effective cadaveric donors ranged between 6 and 10 per million inhabitants. These averages remained stable during this period and are among the lowest in the region. Our analysis attributed these deficient results mainly to low organ donation and inefficient procurement due to lack of compliance with protocols and little accountability. The committee proposes several measures for improvement. These are a systematic and obligatory report of potential organ donors by all emergency and critical care centers, frequent evaluation of results, empowering of health authorities to correct insufficiencies in organ procurement, education programs for primary, secondary, technical and university students to improve their knowledge about the social significance and solidarity required for transplantation policies and specialized updated training of all health professionals involved. Organ donation and transplantation must be based on clear and fair ethical considerations in order to be accepted by the general publicPublication Enseñanza y aprendizaje de la bioética(2022) Beca, Juan PabloItem Ethical and health issues posed by the recent Ebola epidemic: What should we learn?(Sociedad Médica de Santiago, 2016) Beca, Juan Pablo; Salas Ibarra, SofíaThe recent Ebola epidemic that affected several countries in Africa, with very high mortality and a pandemic threat, posed problems of justice, public health, prevention, treatment and research, each of which has relevant ethical issues. Despite severe initial difficulties, an effective international response was achieved, whose outcome has left significant teachings to be considered in order to deal with future epidemics or pandemics. In this article, the authors analyze the main problems faced during the Ebola epidemic, including the unequal distribution of health resources between countries, the need for international collaboration, the requirement for a review of the ethical standards of clinical trials in emergencies, and the necessity of an organized global system of prevention and timely response to these outbreaks. Authors conclude that at the present time health is a global issue without borders, that insufficient healthcare resources in some countries poses risks and affects all countries and that the confrontation of the threats of epidemics requires a solution based in universal solidarity. At the same time, a moral duty to investigate should be acknowledged, seeking a balance between sense of urgency, scientific rigor and involvement of local communities.Item Eutanasia y muerte digna: ¿Cuáles son los valores en juego?(2021) Beca, Juan PabloLa eutanasia, alternativa que en los últimos veinte años está siendo aceptada de manera lenta pero progresiva en algunos países, admite posiciones diversas.Item Eutanasia: aclarando conceptos(2021) Carvajal, Sergio; Portales, María Bernardita; Beca, Juan PabloEuthanasia is a subject of permanent discussion everywhere, mainly about its ethical appropriateness and about its legalization in different countries. This debate includes many ethical, legal, social, political, spiritual, religious, and public health issues. A relevant problem is the frequent misunderstanding that many have about the meaning of the terms and concepts used in different ethical and clinical end of life settings. Many views and even texts are affected by such mistakes, rendering a constructive discussion almost impossible. The goal of this article is to contribute to an improvement of the social and legislative discussion about euthanasia through an elucidation of the main terms and notions linked to this topic. We present definitions and explanations for euthanasia, assisted suicide, withdrawal or foregoing of therapy, treatment rejection, palliative sedation, dignified death and others.Item ¿Existen límites en la toma de decisiones de los padres sobre el tratamiento de los niños?(2010) Beca, Juan Pablo; Mcnab, Maria ElenaEn la práctica de la medicina nos encontramos ocasionalmente con situaciones en las que la opinión médica discrepa con la del paciente acerca de su mayor beneficio. Esta situación se torna aún más compleja cuando son los padres del paciente menor de edad quienes se niegan a que sus hijos reciban un tratamiento que le puede salvar la vida. Se hace necesario precisar hasta dónde luchar por la salud de un niño si sus padres rechazan los tratamientos. Con el propósito de contribuir a establecer criterios en este tema, se presentan tres casos públicos recientes y se analizan los posibles límites de la autoridad de los padres para decidir los tratamientos de sus hijos. Se concluye que es de vital importancia comprender y respetar las creencias de los padres del menor, pero que en último término nuestro compromiso fundamental es con el paciente y su derecho a la vida, razón por la cual se justifica, ante el fracaso de la persuasión, recurrir a los tribunales como última instancia.Item Una experiencia de enseñanza de bioética en Chile(2021) Beca, Juan PabloItem Formas de revisión ética de proyectos de investigación biomédica(Sociedad Medica de Santiago, 2017) Portales, María Bernardita; Michaud, Patricio; Salas Ibarra, Sofía; Beca, Juan PabloTen years after the approval of the Chilean bill that regulates scientific research in humans (Law Nº 20.120), and considering the current status of accreditation and training of many Research Ethics Committee (REC), it is necessary to analyze their performance. We analyzed the Chilean experience with REC aiming to propose a differential type of review, considering the risks to research participants. To improve the quality of the review and the efficiency of these committees, we propose to differentiate the revisions depending on the type of project, its methods and its risks. Initially, the types of review should be classified as exempt from review, expedited review and full review by the committee. In this proposal the type of review is confirmed or can be modified by a designated member of the committee after an initial review of the project. Thus, the deliberation and review times of the committee could be optimized avoiding delays in their revision.Item Hacia un cuidado ético en residencias sanitarias durante la pandemia de COVID-19: estudio cualitativo con migrantes internacionales en Chile(2022) Cabieses, Báltica; Obach, Alexandra; Blukacz, Alice; Carreño, Alejandra; Larenas, Daniel; Mompoint, Emmanuel; Beca, Juan PabloMigrantes internacionales han sido reconocidos como población de riesgo en el contexto de la pandemia de COVID-19. A nivel mundial se han desplegado diversas estrategias para la protección de esta población, como la habilitación de centros de recepción y cuarentena o aislamiento. El artículo da cuenta de los resultados de un estudio que exploró las experiencias de migrantes internacionales en residencias sanitarias dispuestas en Chile para la realización de cuarentenas seguras en el marco de la pandemia COVID-19, desde un enfoque de condiciones éticas para el cuidado. Se realizó un estudio cualitativo entre los años 2020-2021. Se efectuaron 30 entrevistas individuales semi-estructuradas en línea en las ciudades de Arica, Iquique, Antofagasta y Santiago a migrantes internacionales con experiencia de uso de residencias sanitarias; equipos de salud de residencias sanitarias; mánagers de dichos recintos; autoridades locales; y expertos nacionales. Se realizó análisis temático de la información. El estudio concluye que para migrantes internacionales, si bien la experiencia en residencias sanitarias ha significado un apoyo sanitario significativo, es imprescindible que el cuidado proporcionado, además de la exigencia que se enmarque en un enfoque de derechos y de respeto a la dignidad de cada persona, incorpore la perspectiva de la interculturalidad en su quehacer, es decir, asegurando el derecho a servicios de salud culturalmente pertinentes, respetuosos de la cultura de las personas, las minorías, los pueblos y las comunidades.Item Immunity certification for COVID-19: ethical considerations(2021) Reis, Andreas A.; Thomé, Beatriz; Wl Ho, Calvin; Tam, Clarence C.; Kelly-Cirino, Cassandra; Emanuel, Ezekiel; Beca, Juan Pablo; Littler, Katherine; Smith, Maxwell J.; Parker, Michael; Kass, Nancy; Gobat, Nina; Lei, Ruipeng; Upshur, Ross; Hurst, Samia; Munsaka, Sody; Voo, Teck ChuanRestrictive measures imposed because of the coronavirus disease 2019 (COVID-19) pandemic have resulted in severe social, economic and health effects. Some countries have considered the use of immunity certification as a strategy to relax these measures for people who have recovered from the infection by issuing these individuals a document, commonly called an immunity passport. This document certifies them as having protective immunity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes COVID-19. The World Health Organization has advised against the implementation of immunity certification at present because of uncertainty about whether long-term immunity truly exists for those who have recovered from COVID-19 and concerns over the reliability of the proposed serological test method for determining immunity. Immunity certification can only be considered if scientific thresholds for assuring immunity are met, whether based on antibodies or other criteria. However, even if immunity certification became well supported by science, it has many ethical issues in terms of different restrictions on individual liberties and its implementation process. We examine the main considerations for the ethical acceptability of immunity certification to exempt individuals from restrictive measures during the COVID-19 pandemic. As well as needing to meet robust scientific criteria, the ethical acceptability of immunity certification depends on its uses and policy objectives and the measures in place to reduce potential harms, and prevent disproportionate burdens on non-certified individuals and violation of individual liberties and rights.Item Inicios de la especialidad y los cuidados intensivos neonatales en Chile(2021) Stefan Hosiasson, Stefan; Beca, Juan Pablo; Vaisman, SergioLa historia de los inicios en Chile de la implementación nacional de las unidades de cuidados intensivos neonatales, y por ende de los inicios de la neonatología moderna en Chile, es de visionarios motivados exclusivamente por el profundo deseo de mejorar la sobrevida y calidad de vida de pequeños que nacían, muy a su pesar, antes de tiempo. Es una historia que, como muchas otras del desarrollo de la medicina, vale la pena relatar no solo por los logros que alcanzó, sino que también por el proceso de gestación y desarrollo en sí. Recordaremos para ello primero la historia de los orígenes y desarrollo del cuidado de los recién nacidos en el mundo, su avance gradual en el siglo XIX y principios del siglo XX, su consolidación a partir de la década de los 60, y finalmente su impulso en Chile con especial mención de la gestación del programa nacional de cuidados intensivos de prematuros en la década de los 80.