Principialismo, bioética personalista y principios de acción en medicina y en servicios de salud
DOI:
https://doi.org/10.5294/pebi.2018.22.2.3Palabras clave:
bioética, principialismo, personalismo, medicina basada en la evidencia, evaluación de la tecnología, calidad, calidad de la atención de salud, seguridadResumen
Principlism, personalist bioethics and principles of action in medicine and health services
Principialismo, bioética personalista e princípios de ação em medicina e serviços de saúde
Dado que hay una brecha y diferencias entre conceptos bioéticos y otros principios de acción provenientes de la práctica de la medicina moderna, su comparación es razonable. La medicina moderna ha generado principios de acción basados en la evidencia y principios de calidad en medicina, y la argumentación bioética recurre frecuentemente al principialismo, o a la bioética personalista. Este artículo pretende ilustrar las características de las relaciones entre estos conceptos y su potencial enriquecimiento mutuo. Se propone una matriz de comparación simple y práctica, para cotejar la relación entre los principios. Estos conceptos tienen una superposición significativa. Sin embargo, tanto en la historia de las ideas como en su formulación son muy diferentes. Se enfatiza el valor contextual de este análisis dado por las tendencias de la salud global, y algunas implicaciones para la medicina de bioética personalista.
Para citar este artículo / To reference this article / Para citar este artigo
Insua JT. Principialismo, bioética personalista y principios de acción en medicina y en servicios de salud. pers. bioét. 2018; 22(2): 223-246. DOI: 10.5294/pebi.2018.22.2.3
Descargas
Citas
Marcum JA. Humanizing Modern Medicine An Introductory Philosophy of Medicine. New York: Springer, 2008.
Morse G. Interview to Atul Gawande: Health Care Needs a New Kind of Hero. Harvard Bussiness Review, 2010 (visitado 2018 nov 27). Disponible en: https://hbr.org/2010/04/healthcare-needs-a-new-kind-of-hero
Graber GC, Thomasma D. Theory and practice in medical ethics. New York: Continuum; 1989.
Solomon D. Ethics: Rules and Principles. In Reich, WT, editor. Encyclopedia of Bioethics. New York: Macmillan; 1978. p. 407-413.
Aschley B. The Way Toward Wisdom. Indiana: Univ. Notre Dame Press; 2006.
Romano G. El poder. Madrid: Editorial Cristiandad; 1982.
Maritain J. Lessons in Moral Philosophy. New York: Magi Books; 1990.
Finnis J. Natural Law and Natural Rights. Oxford: Clarendon Press; 1980.
Pellegrino ED, Thomasma DC. The Virtues in Medical Practice. Oxford: Oxford University Press;1993.
McIntyre A. After Virtue: a Study in Moral Theory, 3 ed. Indiana: Notre Dame Press; 2007. p. 146-181.
Braude HD. Intuition in Medicine. Chicago: Chicago Univ. Press; 2012, p. 1-17.
Beauchamp TL. Ethical Theory and Bioethics. In Beauchamp TL, Le Roy W. Contemporary issues in Bioethics, 3 ed. Belmont, CA: Wadsworf Publ. Co.; 1989.
Sgreccia E. Manual de Bioética. I: Fundamentos y Ética Biomédica. 4 ed. Madrid: BAC; 2007.
Chandra A, Khullar D, Lee TH. Addressing the Challenge of Gray-Zone Medicine. N Engl J Med. 2015; 372:203-5. DOI: 10.1056/NEJMp1409696
Muir Gray JA. Evidence Based Health Care. London: Churchill Livingstone; 1997.
Veatch R. The Basics of Bioethics, 3 ed. Washington: Norton; 2012.
Sackett DL, Rosenberg WMC, et al. Evidence Based Medicine: What it is and What it Isn’t. BMJ. 1996;312:71-2. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2349778/
Goodman KW. Ethics and Evidence-Based Medicine. Cambridge: Cambridge University Press; 2003. p. 129-140.
Wilsdon T, Serota A. A Comparative Analysis of the Role and Impact of Health Technology Assessment. London: Charles River Associates; 2011 (visitado 2018 nov 27). Disponible en: https://www.phrma.org/report/a-comparative-analysis-of-therole-and-impact-of-health-technology-assessment
Augustovski F, Alcaraz A, Caporale J, García S, Pichon A. Institutionalizing health technology assessment for priority setting and health policy in Latin America: from regional endeavors to national experiences. Expert Review of Pharmacoeconomics & Outcomes Research. 2015;15:9-12. DOI: 10.1586/14737167.2014.963560
Pichon-Riviere A, Soto NC, Augustovski FA, García S, Sampietro- Colom L. Evaluación de tecnologías Sanitarias para la toma de decisiones en Latinoamérica: principios de buenas prácticas. Rev Panam Salud Publica. 2017;41:e138. Disponible en: http://iris.paho.org/xmlui/handle/123456789/34364
Callahan D. Ends and Means: The Goals of Health Care. In Danis M, Clancy C, Churchill L, editors. Ethical Dimensions of Health Policy. London: OUP; 2002. p. 3-18.
Insua JT, Tibaudin O. Enfermedad Crónica no Transmisible. Editum, 2018.
McIntyre A. Three Rival Versions of Moral Enquiry: Encyclopedia, Genealogy, and Tradition. Indiana: Notre Dame Univ Press; 1990.
Rawlins MD, Culyer AJ. National Institute for Clinical Excellence and its Value Judgments. BMJ. 2004;329(7459):224-7. DOI: 10.1136/bmj.329.7459.224
Arras JD. Methods in Bioethics The Way We Reason Now. Childress J, Adams M, editors. Oxford: Oxford University Press 2017. p. 1-26.
Beauchamp TL, Rauprich O. Principlism. In Henk ten Have, editor. Encyclopedia of Global Bioethics. New York: Springer; 2016. p. 2282-2292.
Office of the Secretary Ethical Principles and Guidelines for the Protection of Human Subjects of Research The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report. Disponible en: https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html
Beauchamp T, Childress JF. Principles of Biomedical Ethics. Oxford: Oxford University Press; 2013.
Bernard Gert, Charles M. Culver, K. Danner Clouser. Bioethics: A return to fundamentals. Oxford: Oxford University Press; 1997.
Bernard Gert, Charles M. Culver, K. Danner Clouser. Bioethics: A systematic approach, 2nd ed. Oxford: Oxford University Press; 2006.
Veatch RA. Justice in Health Care: The Contribution of ED Pellegrino. J Med Phil. 1990;15:269-87.
Diego Gracia. The historical Setting of Latin American Bioethics. In Pessini L, Barchifontaine Ch, Lolas Stepke F. editors. Ibero-American Bioethics: History and Perspectives. New York: Springer; 2010. p. 3-20.
Juan Manuel Burgos. Introducción al Personalismo. Madrid: Biblioteca Palabra; 2012.
Buford Th. Personalism. In Henk ten Have, editor. Encyclopedia of Global Bioethics. New York: Springer; 2016. p. 2204-2213.
Burgos JM. Introducción al personalismo. Madrid: Asociación Española de personalismo; s. f. Disponible en: http://www.personalismo.org/introduccionpersonalismo/
Burgos JM. ¿Qué es la bioética personalista? Análisis de su especificidad y sus fundamentos teóricos. Cuadernos de Bioética XXIV. 2013;1:17-30. Disponible en: http://www.personalismo.org/burgos-juan-manuel-que-es-la-bioeticapersonalista- un-analisis-de-su-especificidad-y-de-susfundamentos- teoricos/
Cochrane AL. Effectiveness and efficiency. Random reflections on health services. London: Nuffield Hospitals Trust; 1972.
National Institute for Health and Clinical Excellence. Social Value Judgements: Principles for the Development of NICE Guidance, 2 ed. NIHCE; 2005 (visitado 2018 nov 29). Disponible en: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0089902/pdf/PubMedHealth_PMH0089902.pdf
Finkelman S. La epidemiología clínica hegemónica. Medicina. 2006;66:275-6.
OMS. Cómo tomar decisiones justas en el camino hacia la cobertura universal de salud. Informe final del Grupo Consultivo de la OMS sobre la Equidad y Cobertura Universal de Salud. Washington, DC: OPS; 2015.
Insua JT. Implicancias éticas de la medicina basada en la evidencia: limitaciones, alcances, pretensiones; 2013 (inédito).
Muir Gray JA. Evidence Based Health Care and Public Health, 3 ed. Edinburgh: Churchill Livingstone; 2009.
Haynes B, Sackett D, Guyatt GH, Tugwell P. Clinical Epidemiology. 3 ed. Philadelphia: Lippincott Williams & Wilkins; 2006.
Hill GB. Archie Cochrane and his Legacy. An Internal Challenge to Physicians’ Autonomy? J Clin Epidemiol. 2000; 53:1189-92. DOI: 10.1016/S0895-4356(00)00253-5
Muir Gray JA. Evidence based healthcare. 2 ed. Edinburgh: Churchill Livingstone; 2001.
Wikipedia. Disease Control Priorities Project (DCP) (visitado 2018 nov 29). Disponible en: https://en.wikipedia.org/wiki/Disease_Control_Priorities_Projectdcp-3.org
Disease Control Priorities. Economic evaluation for health. Disponible en: http://dcp-3.org/disease-controlpriorities
2018 Top 10 HEOR Trends. International Society of Pharmacoeconomics and Outcome Research (ISPOR); 2018.
Aday ML, Begley C, Lairson DR, Slatter CH. Evaluating the Health Care System: Effectiveness, Eficiency and Equity. Chicago: HAP; 1998. p. 298-318.
Leipzig RM. Evidence-Based Medicine and Geriatrics. In Cassel CK, Leipzig RM, Cohen H, Larson EB, Meier D, editors. Geriatric Medicine: An Evidence-Based Approach, 4th ed. New York: Springer-Verlag Inc.; 2003.
Povar G. What does Quality Mean: Ethical issues in Quality Assurance. In Palmer RH, Donabedian A, Povar GJ, editors. Striving for Quality in Health Care: An Inquiry into Policy and Practice. Chicago: HAP; 1991. p. 131-168.
Committee on Quality Health Care in America, Institute of Medicine (IOM). Crossing the Quality Chasm: a New Health Care System for the 21st Century. Washington DC: National Academy Press; 2001.
Institute of Medicine (IOM). Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes and Innovation: Workshop Summary. Washington, DC: The National Academies Press; 2010.
Insua JT. Gestión clínica, dirección médica moderna y gestión de cuidados clínicos. En: Bascolo E, editor. Desarrollo de instrumentos de gestión como estrategia de cambio. Proc. I Jornadas de Economía y Gestión de Salud. Administración de Servicios de Salud. Rosario: Universidad Nacional de Rosario (UNR); 2002. p. 41-72.
Insúa JT. En las fronteras de la ética de la investigación clínica: ajustando las normas al progreso. Revista Argentina de Cardiología. 2017;85(2):129-34. Disponible en: https://www.sac.org.ar/wp-content/uploads/2017/07/v85n2a09-es.pdf
Sachs GA, Cohen HJ. Ethical Challenges to Research in Geriatric Medicine. In Cassel CK, Leipzig RM, Cohen H, Larson EB, Meier, editors. Geriatric Medicine: An Evidence-Based Approach, 4th ed. New York, Springer-Verlag; 2003. p.1253-61.
Epstein RS, Sherwood LM. From Outcomes Research to Disease Management: A Guide for the Perplexed. Ann Intern Med. 1996;124:832-7. DOI: 10.7326/0003-4819-124-9- 199605010-00008
Jennings B, Baily MA, Botrell M, Lynn J, editors. Health Care Quality Improvement: Ethical and Regulatory Issues. New York: Hastings Center Report; 2007.
Kohn LT, Corrigan JM, Donaldson MS, editors. Institute of Medicine (IOM). Committee on Quality of Health Care in America; To Err is Human: Building a Safer Health System. Washington (DC): National Academic Press; 2000.
Aspden P, Corrigan JM, Wolcott J, Erickson SM, editors. Patient Safety: Achieving a New Standard of Care. Washington, DC: The National Academies Press; 2004. Apendix B.
Aranaz-Andres JM, Aibar-Remon C, Limon-Ramirez R, et al. Prevalence of Adverse Events in the Hospitals of Five Latin American Countries: Results of the Iberoamerican Study of Adverse Events’ (IBEAS). BMJ Qual Saf. 2011;20:1043-51. DOI: 10.1136/bmjqs.2011.051284
Fajreldines AV, Insua JT, Schnitzler E. Prescripción inapropiada en adultos mayores hospitalizados. Medicina. 2016;76(6): 362-8. Disponible en: https://www.medicinabuenosaires.com/revistas/vol76-16/n6/362-368-Med76-3-6408-Fajreldines-A%20oJo%20anexo%20solo%20web--.pdf
Porter ME. What is Value in Health Care? N Engl J Med. 2010;363:2477-81. DOI: DOI: 10.1056/NEJMp1011024
Bae J-M. Value-Based Medicine: Concepts and Application. Epidemiol Health. 2015;37:e2015014. DOI: 10.4178/ epih/e2015014
Fulford KWM. The Value of Evidence and Evidence of Values: Bringing Together Values-Based and Evidence-Based Practice in Policy and Service Development in Mental Health. J Eval Clin Pract. 2011;17:976-87. DOI: 10.1111/j.1365- 2753.2011.01732.x
Fulford KM. Values-based practice: Fulford’s dangerous idea. J Eval Clin Pract. 2013;19:537-46. DOI: 10.1111/jep.12054
Fulford KWM. Bringing Together Values-Based and Evidence- Based Medicine: UK Department of Health Initiatives in the ‘Personalization’ of Care. J Eval Clin Pract. 2011;17:341-3. DOI: 10.1111/j.1365-2753.2010.01578.x
Gupta M. Values-Based Practice and Bioethics: Close Friends Rather than Distant Relatives. Commentary on ‘Fulford. The Value of Evidence and Evidence of Values: Bringing Together Values-Based and Evidence-Based Practice in policy and Service Development in Mental Health’. J Eval Clin Pract. 2011;17:992-5. DOI: 10.1111/j.1365-2753.2011.01734.x
Moriates C, Arora V, Shah N, editors. Value-Based Health Care. New York: McGraw Hill Medical/Lange; 2015.
Yong PL, Saunders RS, Olsen LA, editors. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series. Institute of Medicine (US) Roundtable on Evidence-Based Medicine. Washington (DC): National Academic Press; 2010.
Kane R, Kane R. Understanding Outcomes Research. New York: Aspen; 1997.
Turpin RS, Waters H. Introduction to Patient Reported Outcomes. In Esposito D, Migliaccio K, Molsen E, editors. Reliabitity and Validity of Data Sources for Outcomes Research and Health Management Programs. Lawrenceville, NJ, USA: Ispor; 2013. p.133-140.
O’Grady L, Jadad A. Shifting from Shared to Collaborative Decision Making: A Change in Thinking and Doing. J Participat Med. 2010;2:e13. Disponible en: https://participatorymedicine.org/journal/evidence/case-studies/2010/11/08/shiftingfrom- shared-to-collaborative-decision-making-a-change-inthinking-and-doing-4/
Schröder-Bäck P, Duncan P, Sherlaw W, Brall C, Czabanowska K. Teaching Seven Principles for Public Health Ethics: Towards a Curriculum for a Short Course on Ethics in Public Health Programmes. BMC Medical Ethics. 2014 (visitado 2018 nov 29). Disponible en: http://www.biomedcentral.com/1472-6939/15/73
Barros AJ, Santos IS, Matijasevich A et al. Patterns of Deliveries in a Brazilian Birth Cohort: Almost Universal Cesarean Sections for the Better-off. Rev Saude Publica. 2011;45:635- 43. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794425/
Gibbons L et al. The Global Numbers and Costs of Additionally Needed and Un-Necessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage. World Health Report. Geneva: World Health Organization; 2010.
Rogers EM. Diffussion of Innovations. New York: Free Press; 2003.
Elshaug AG et al. Levers for Addressing Medical Underuse and Overuse: Achieving High-Value Health Care. Lancet. 2017;(390):191-202. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32586-7/fulltext
Organisation for Economic Cooperation and Development. Geographic Variations in Health Care: What do We Know and What Can be Done to Improve Health System Performance? 2014 (visitado 2016 dec 5). Disponible en: https://www.oecd.org/els/health-systems/FOCUS-on-Geographic-Variations-in-Health-Care.pdf
Mosley WH, Chen LC. An Analytical Framework for the Study of Child Survival in Developing Countries. Bull World Health Organ. 2003;81:140-5. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2572391/pdf/12756980.pdf
Woolf SH. Potential Health and Economic Consequences of Misplaced Priorities. JAMA. 2007;297:523-6. DOI: 10.1001/ jama.297.5.523
Topol E. The Patient Will See You Now. New York: Basic Books; 2015.
Sulmassy D, Sugarman J. The Many Methods of Medical Ethics (Or , Thirteen Ways of Looking at a Blackbird). In Sulmassy D, Sugarman J, editors. Methods in Medical Ethics. Washington DC: Georgetown University Press; 2001. p. 3-18.
Wagner EH, Austin BT, von Korff M. Organizing Care for Patients with Chronic Illness. Milbank Q. 1996;74(4):511-44.
Zitter M. A New Paradigm in Health Care Delivery: Disease Management. In Todd WE, Nasch D, editors. Disease Management: A System´s Approach to Improving Patient Outcomes. Palatine Ill: AHA Publ.; 1996.
Ferrater Mora J. Voz: “Ética”. En Diccionario de Filosofía. Buenos Aires: Editorial Sudamericana; 1965.
Brugarola M. Sociología y teología de la técnica. Madrid: BAC; 1967. p. 176-83.
Oxford Diccionary. Disponible en: https://en.oxforddictionaries.com/definition/ethics
Aristóteles. Ética nicomaquea. Madrid: Gredos; 2011.
Insua JT. Evidencia, economía clínica y resultados. Buenos Aires: MSD Publication/MSD Evidence Based Medicine and Health Economics Group; 1997. p. 1-60.
Taylor HA. Incorporating Ethics into Teaching Health Policy Analysis. In Strech D, Hirschberg I, Marckmann G, editors. Ethics in Public Health and Health Policy. Concepts, Methods, Case Studies. Public Health Ethics 1. Series. Dordrecht: Springer; 2013. p. 83-118.
Medical Technology Assessment Directory: A Pilot Reference to Organizations, Assessments, and Information Resources. Council on Health Care Technology. National Academy Press, Washington, D.C.; 1988.
Goodman CS. HTA 101: Introduction to Health Technology Assessment. National Information Center on Health Services Research and Health Care Technology (NICHSR). May 2014 (visitado 2018 jun 02). Disponible en: https://www.nlm.nih.gov/nichsr/hta101/ta10101.html
Insua JT. Evaluación económica de procedimientos, tecnologías y medicamentos. En Vasallo C, editor. Economía de la Salud. 1er Seminario de Economía de la Salud para Periodistas. Buenos Aires: Roche; 2006. p.17-26.
Rundall T. Health Planning and Evaluation. In Last JM, Wallace RB, editors. Public Health and Preventive Medicine, 13 ed. New York: Appleton Century Crofts; 1991. p.1079-1094.
Publicado
Cómo citar
Número
Sección
Licencia
Esta revista y sus artículos se publican bajo la licencia CreativeCommons CC BY 4.0 DEED Atribución 4.0 Internacional, usted es libre de: Compartir — copiar y redistribuir el material en cualquier medio o formato para cualquier propósito, incluso comercialmente. Adaptar — remezclar, transformar y construir a partir del material para cualquier propósito, incluso comercialmente. La licencia no puede revocar estas libertades en tanto usted siga los términos de la licencia.
