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Abstract 19. Literature points to the existent diversity in medical graduate courses' curriculums, reinforcing the need to systematise and deepen more studies in this area with the aim of qualifying the formation of our future professionals. This study aims to understand the methods used in the teaching of Bioethics in medical graduation worldwide. It was characterised as an integrative review and the databases used were Pubmed, Scopus and Web of Science. In total 2993 articles were identified and 72 met the pre-selected criteria and were included in the review. The characteristics of teaching bioethics that stood out the most in the analysis were: teaching still very heterogeneous between different universities, use of various methodologies in the process of teaching/learning, teaching disconnected from the medical practice of students showing the need to integrate the curriculum with clinical practice and challenges of teaching-learning process. Most of the studies in this review lead us to understand that there is still no minimum parameters on the ideal method to teach bioethics, suggesting that it may affect the feeling of unpreparedness felt by students in face of ethical issues in clinical practice, despite the theoretical basis acquired.

Resumen 23. La literatura apunta a la diversidad existente en los currículos de los posgrados de medicina, reforzando la necesidad de sistematizar y profundizar más estudios en esta área, con el fin de capacitar la formación de nuestros futuros profesionales. Este estudio tiene como objetivo comprender los métodos utilizados en la enseñanza de la bioética en la graduación médica en el mundo. Se caracterizó como una revisión integradora y las bases de datos utilizadas fueron Pubmed, Scopus y Web of Science. En total se identificaron 2.993 artículos, 72 cumplieron los criterios preseleccionados y se incluyeron en la revisión. Las características de la enseñanza de la bioética que más se destacaron en el análisis fueron: docencia aún muy heterogénea entre diferentes universidades, uso de diversas metodologías en el proceso de enseñanza/aprendizaje, docencia desconectada de la práctica médica de los estudiantes, mostrando la necesidad de integrar el currículo con la práctica clínica y los desafíos del proceso de enseñanza/aprendizaje. La mayoría de los estudios de esta revisión nos lleva a entender que aún no existen parámetros mínimos sobre el método ideal para enseñar bioética, sugiriendo que puede impactar en la falta de preparación que sienten los estudiantes ante cuestiones éticas en la práctica clínica, a pesar de las teorías base adquiridas.

Resumo: 27. Vários estudos relatam a diversidade existente nos currículos da graduação em medicina, reforçando a necessidade de sistematizar e aprofundar mais estudos nesta área com o objetivo de qualificar a formação dos nossos futuros profissionais. Este estudo tem como objetivo compreender os métodos utilizados no ensino da Bioética na graduação em medicina em todo o mundo. Esse estudo caracterizou-se como revisão integrativa e as bases de dados utilizadas foram Pubmed, Scopus e Web of Science. No total, foram identificados 2.993 artigos e 72 atenderam aos critérios pré-selecionados e foram incluídos na revisão. As características do ensino da bioética que mais se destacaram nas análises foram: ensino ainda muito heterogêneo entre as diferentes universidades, utilização de diversas metodologias no processo de ensino / aprendizagem, ensino desvinculado da prática médica dos alunos evidenciando a necessidade de integração curricular com a prática clínica e os desafios do processo ensino-aprendizagem. A maioria dos estudos desta revisão nos leva a entender que ainda não existem parâmetros mínimos sobre o método ideal de ensino da bioética e traz como um desafio importante o despreparo sentido pelos alunos frente às questões éticas na prática, apesar da fundamentação teórica adquirida.

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Resumo Está cada vez mais evidente que a reflexão sobre ciências humanas e deontologia é necessária para a formação mais abrangente do estudante de medicina, visando preparar não apenas profissionais tecnicamente capacitados, mas também humanizados. Diante disso, e a fim de seguir as diretrizes curriculares nacionais atuais, as Faculdades Integradas do Norte de Minas instituíram módulo no sexto período de medicina chamado "Humanidades, Bioética e Antropologia Médica". Objetivando avaliar a percepção de alunos sobre o ensino de ética nessa instituição, esta pesquisa aplicou questionário a estudantes do sétimo ao décimo períodos do curso de medicina. O instrumento contava com perguntas sobre a estruturação do módulo e o ensino de ética. Os resultados evidenciaram a proposta inovadora do módulo e a importância da ética médica na grade curricular no sentido de contribuir para a formação de médicos mais humanos.

Abstract It is increasingly evident that reflection on humanities and deontology is necessary for a more comprehensive training of medical students, aimed at preparing professionals that are not only technically qualified, but also humanized. For this reason and also to follow the current national curriculum guidelines, Faculdades Integradas do Norte de Minas introduced a new module in the sixth period: "Humanities, Bioethics and Medical Anthropology." Aiming to evaluate student perception about the teaching of ethics in the institution, this research applied a questionnaire to the students (seventh to tenth period) of the medical course. The instrument comprised questions on the module's structure and the teaching of ethics. Results show the importance of including medical ethics in the medical curriculum for a more humanized formation of doctors.

Resumen Cada vez es más evidente que la reflexión sobre humanidades y deontología es necesaria para la formación integral del estudiante de medicina, con el objetivo de preparar no solo profesionales técnicamente calificados, sino también humanizados. Por lo tanto, y con el fin de seguir las actuales directrices curriculares nacionales, las Facultades Integradas del Norte de Minas establecieron un módulo en el sexto período de medicina denominado "Humanidades, Bioética y Antropología Médica". Con el fin de evaluar la percepción de los estudiantes sobre la enseñanza de la ética en esta institución, esta investigación aplicó un cuestionario a estudiantes del séptimo al décimo período de la carrera de medicina. El instrumento tenía preguntas sobre la estructuración del módulo y la enseñanza de la ética. Los resultados mostraron la propuesta innovadora del módulo y la importancia de la ética médica en el plan de estudios para contribuir a la formación de futuros médicos más humanos.

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Resumo: Introdução: Os valores humanos e as virtudes éticas que norteiam a ação médica na sociedade contemporânea são um tema deveras importante, contudo pouco tematizado e enfatizado no processo de formação dos futuros médicos. Objetivo: Dada a suma complexidade do assunto para a formação profissional integral, haja vista a medicina ser uma ciência sobretudo humana que alia técnica e conhecimento ao bem-estar das pessoas, faz-se necessário problematizar quais os principais desafios bioéticos na formação médica sob uma perspectiva teleológica e axiológica. Métodos: Por meio de um artigo de reflexão, far-se-á uma análise sistemático-crítica conceitual das principais virtudes e dos principais valores debatidos e refletidos na tradição ética ocidental mediante cotejamento bibliográfico à luz do atual estado da arte do processo formativo médico. Resultado: A preocupação didático-pedagógica com valores e virtudes ético-morais, tais como caráter, amor, liberdade, respeito, responsabilidade, compaixão, paciência, humildade, fortaleza, prudência, justiça e coragem, entre outros, não está sendo privilegiada no ensino médico. Há um déficit nessa dimensão, dificultando o amadurecimento e a aprendizagem de práticas ético-morais indispensáveis em nosso tempo. Conclusão: O atual estágio do exercício da profissão médica, imersa num paradigma tecnicista, requer, cada vez mais, profissionais com uma formação humanista e não apenas tecnopragmática. Os desafios advindos de uma sociedade multifacetada, em constante evolução, exigem que as universidades e faculdades médicas enfoquem, precipuamente, as dimensões axiológicas e ético-morais na formação.

Abstract: Introduction: Although the human values and ethical virtues that guide medical action in contemporary society constitute a very important theme, they are given little emphasis in medical training. Objective: Given the complexity of this issue in relation to comprehensive professional training, and since medicine is - an above all human - science, that combines technique and knowledge with people's well-being, it is necessary to question the main bioethical challenges in medical training from a teleological and axiological perspective. Methods: In a reflection paper, a systematic-critical conceptual analysis of the main virtues and values debated and reflected in the Western ethical tradition is conducted by means of bibliographic comparison in light of the current state of the art of the medical training process. Results: A didactic-pedagogical concern with ethical-moral values and virtues such as character, love, freedom, respect, responsibility, compassion, patience, humility, fortitude, prudence, justice and courage, is not being prioritised in medical education. There is a deficit in this dimension, making it difficult for students to mature and learn the ethical-moral practices that are indispensable in our time. Conclusion: The current stage in the exercise of the medical profession immersed in a technicalist paradigm increasingly requires professionals with a humanist and not just techno-pragmatic background. The challenges that emerge from a constantly changing and multifaceted society require universities and medical faculties to focus, above all, on the axiological and ethical-moral dimensions of training.

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Resumo Impulsionadas pelas Diretrizes Curriculares Nacionais do curso de graduação em medicina, publicadas em 2001, as universidades reestruturaram seus currículos a fim de articular a prática médica ao Sistema Único de Saúde, dando maior atenção às humanidades. A Faculdade de Medicina da Universidade Federal da Bahia reformulou seu currículo em 2007, implantando o eixo ético-humanístico, ofertado do primeiro ao oitavo semestre. Este estudo analisa a percepção acerca desse eixo com base em questionário respondido por 418 estudantes. A maioria dos participantes afirmou conhecer os objetivos do eixo ético-humanístico, mas acredita que seus colegas de curso não o consideram importante para a formação. A maior parte diz privilegiar disciplinas dos módulos biológico e clínico, mas considera necessário que disciplinas do eixo ético-humanístico estejam presentes em todos os semestres.

Abstract Universities have been restructuring their curricula to direct medical practice onto the Brazilian Unified Health System, driven by the publication of the National Curricular Guidelines for the Undergraduate Medical Course in 2001, by introducing humanities as an important instrument to the students' education. The Faculty of Medicine of Bahia, Brazil, reformulated its curriculum in 2007 and implemented the ethical-humanistic axis, provided from the first to the eighth semester of the course, aiming at adapting the education of physicians to the profile proposed by the guidelines. Our study analyzes the students' perception of this axis in the curriculum. Questionnaires were applied to obtain 418 respondents. The students know the objectives of the ethical-humanistic axis; however, they think their colleagues do not consider the axis important for their education. Although most of students favor subjects from the biological and clinical modules, they also consider the disciplines of the ethical-humanistic axis should be present in all semesters.

Resumen Impulsadas por la publicación de las Directrices Curriculares Nacionales para el Curso de Grado en Medicina, publicadas en 2001, las universidades reestructuraron sus planes de estudio para articular la práctica médica al Sistema Único de Salud, para lo que concedieron mayor atención a las humanidades. La Facultad de Medicina de la Universidad Federal de Bahía reformuló su plan de estudios en 2007 e implementó el eje ético-humanístico, ofrecido desde el primero hasta el octavo semestre. Este estudio analiza la percepción de este eje, sobre la base de un cuestionario al que respondieron 418 estudiantes. La mayoría de los participantes afirmó que conocía los objetivos del eje ético-humanista, aunque piensan que sus compañeros de curso no lo consideran importante para su formación. La mayor parte afirma que prioriza las disciplinas de los módulos biológico y clínico, aunque considera necesario que las disciplinas del eje ético-humanista estén presentes en todos los semestres.

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Physicians values are largely supported by a socio-cultural moral basis, also known as "classical utilitarianism". Technological advances and social questions to physicians show their paucity of an ethical conceptualization in medicine. A new way of approaching ethical conflicts in medicine should be constructed. Training should promote ethical reflection about these conflicts and about the actions of physicians. Ontogenetic and phylogenetic research on human nature, and the advances in moral psychology, could allow us to understand the construction of our judgment of values. An introspective emotional and rational effort to understand "how we are" and from there, to "how we act" lacks among physicians. This issue is even more complex in a political-social model which does not stimulate this type of analysis. The university space is a privileged opportunity to educate. The student must be envisioned as a human being whose professional acts should consider the needs of our society, aiming at a new ethical conceptualization in medicine.

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Physicians values are largely supported by a socio-cultural moral basis, also known as "classical utilitarianism". Technological advances and social questions to physicians show their paucity of an ethical conceptualization in medicine. A new way of approaching ethical conflicts in medicine should be constructed. Training should promote ethical reflection about these conflicts and about the actions of physicians. Ontogenetic and phylogenetic research on human nature, and the advances in moral psychology, could allow us to understand the construction of our judgment of values. An introspective emotional and rational effort to understand "how we are" and from there, to "how we act" lacks among physicians. This issue is even more complex in a political-social model which does not stimulate this type of analysis. The university space is a privileged opportunity to educate. The student must be envisioned as a human being whose professional acts should consider the needs of our society, aiming at a new ethical conceptualization in medicine.

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The Chilean Law regulating the voluntary interruption of pregnancy, contemplates the possibility that health personnel may refrain from doing the procedure if they have stated that they are conscientious objectors (CO). There are numerous articles on the subject. However, the impact on medical training centers when a student or resident abstain from performing certain clinical procedures invoking CO, has seldom been analyzed. In this article, we explore the rights and duties of the CO students to perform an abortion or other clinical procedures for either religious or cultural reasons. Based on international experience, we recommend that all health care centers should have established and publicly known policies on this matter. Finally, we honor CO invoked by students, based on three general principles. First, the autonomy and moral integrity of the students should be respected. Second, an adequate ethical sensitivity is promoted. Third, it contributes to the necessary heterogeneity and diversity of students, promoting a desirable pluralism. However, certain interests and values, such as the well-being of patients, must be considered over and above accepting the CO requests.

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The Chilean Law regulating the voluntary interruption of pregnancy, contemplates the possibility that health personnel may refrain from doing the procedure if they have stated that they are conscientious objectors (CO). There are numerous articles on the subject. However, the impact on medical training centers when a student or resident abstain from performing certain clinical procedures invoking CO, has seldom been analyzed. In this article, we explore the rights and duties of the CO students to perform an abortion or other clinical procedures for either religious or cultural reasons. Based on international experience, we recommend that all health care centers should have established and publicly known policies on this matter. Finally, we honor CO invoked by students, based on three general principles. First, the autonomy and moral integrity of the students should be respected. Second, an adequate ethical sensitivity is promoted. Third, it contributes to the necessary heterogeneity and diversity of students, promoting a desirable pluralism. However, certain interests and values, such as the well-being of patients, must be considered over and above accepting the CO requests.

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Based on the epidemiological surveys on mental health applied to Health Science students of the School of Medicine (Medicine, Nursing, Obstetrics, Nutrition, and Medical Technology) of Universidad Nacional Mayor de San Marcos, the author postulates that there are two ways to understand the teaching needs of ethics: 1) as a curricular strategy, with theoretical information through specific courses; and, 2) as a support to the moral development of the personality with diverse innovative methods. Based on the results of the surveys mentioned, which show lifetime prevalence of suicide attempts and dissocial behaviors greater than in the general population, it is proposed that such teaching shall be planned for two groups of students with different needs: 1) those without a mental health pathology and who can benefit from the regular curricular strategy; and, 2) those who, with mental health problems and indicators of difficulties in their social behavior, shall also be helped with techniques aimed at offering them support in their moral development. And that this educational challenge must be the responsibility of the university of the 21st century, under the question: What does our country need, health professionals who know ethics or who behave ethically?

Tomando como base las encuestas epidemiológicas sobre salud mental aplicadas a estudiantes de las Ciencias de la Salud de la Facultad de Medicina (Medicina, Enfermería, Obstetricia, Nutrición y Tecnología Médica) de la Universidad Nacional Mayor de San Marcos, el autor postula que existen dos formas de entender las necesidades de enseñanza de la ética: 1) Como estrategia curricular, con información teórica a través de cursos específicos; y, 2) Como soporte al desarrollo moral de la personalidad con diversas metódicas innovadoras. Apoyándose en los resultados de las encuestas citadas, que evidencian prevalencias de vida de intento suicida y conductas disociales mayores que en población general, se plantea que tal enseñanza debe planificarse para dos grupos de alumnos con diferentes necesidades: 1) Aquellos que sin patología de salud mental pueden beneficiarse con la estrategia curricular regular; y, 2) Aquellos que, presentando problemas de salud mental e indicadores de dificultades en su conducta social, deben, además, ser ayudados con técnicas orientadas a ofrecerles apoyo en su desarrollo moral. Y que este reto educativo debe ser responsabilidad de la universidad del siglo XXI, bajo la pregunta de ¿qué necesita nuestro país, profesionales de la salud que sepan ética o que se comporten éticamente?

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Modern ethics, with its rationalism, has resulted in a dialectic between deontologism and teleologism that fragments practical reasoning into two dimensions: intuitive-transcendental and calculator-utilitarian. Inflexibility and casuistry are a consequence of this philosophy which vainly tries to give a foundation to duty. For modern philosophy, the first thing is the law, the principles from which obligations arise. Classical philosophy, on the other hand, penetrates into the nature of man and thus knows, better and better each day, the true good for the human person. It is a question of manifesting the "must be" from the "being," the ethics from the knowledge of the metaphysics of the act of being, thus overcoming the "naturalist fallacy." The appreciation and respect of the person as a subject who possesses a supreme value is what underpins this anthropologically-based ethics. Based on the foundation of ethics and bioethics in the philosophy of the being and anthropology, but not limited exclusively to a bioethical approach that disregards the contributions of other currents. For the study of medicine, we propose a humanistic plan that includes courses in philosophy, anthropology, ethics, and bioethics. This plan is mainly worked on in the early years of training but continues throughout the study of medical sciences and is completes, at the end, with the clinical courses. At the same time, the proposal goes beyond the teaching of the subjects per se and goes across the entire curriculum. The integral education that is sought for the medical student is not obtained only with the existence of certain subjects or credits, but it is guaranteed by the teaching work of all.

La ética moderna, con su racionalismo, ha derivado en una dialéctica entre deontologismo y teleologismo que fragmenta la razón práctica en dos dimensiones: intuitiva-trascendental y calculadora-utilitarista. La inflexibilidad y la casuística son consecuencia de esta filosofía que intenta vanamente dar un fundamento al deber. Para la filosofía moderna, lo primero es la ley, los principios a partir de los cuales surgen las obligaciones. En cambio, la filosofía clásica penetra en la naturaleza del hombre y así conoce, cada vez mejor, el auténtico bien para la persona humana. Se trata de manifestar el «deber ser¼ a partir del «ser¼, la ética desde el conocimiento de la metafísica del acto de ser, superando así la «falacia naturalista¼. El aprecio y el respeto de la persona como un sujeto que posee un valor supremo es lo que fundamenta esta ética con base antropológica. En base a la fundamentación de la ética y la bioética en la filosofía del ser y la antropología, pero sin circunscribirse de manera exclusiva en un planteamiento bioético que desprecie los aportes de otras corrientes. Proponemos, para la carrera de medicina, un plan humanístico que incluya cursos de filosofía, antropología, ética y bioética. Este plan se trabaja fundamentalmente en los primeros años pero continúa a lo largo de las ciencias médicas y culmina, ya al final, en los cursos de clínicas. Al mismo tiempo, la propuesta va más allá del dictado de las propias materias y atraviesa toda la malla curricular. La formación integral que se busca para el estudiante de medicina no se consigue sólo con la existencia de determinadas asignaturas o créditos, sino que va avalada por el trabajo docente de todos.

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La ética moderna, con su racionalismo, ha derivado en una dialéctica entre deontologismo y teleologismo que fragmenta la razón práctica en dos dimensiones: intuitiva-trascendental y calculadora-utilitarista. La inflexibilidad y la casuística son consecuencia de esta filosofía que intenta vanamente dar un fundamento al deber. Para la filosofía moderna, lo primero es la ley, los principios a partir de los cuales surgen las obligaciones. En cambio, la filosofía clásica penetra en la naturaleza del hombre y así conoce, cada vez mejor, el auténtico bien para la persona humana. Se trata de manifestar el «deber ser¼ a partir del «ser¼, la ética desde el conocimiento de la metafísica del acto de ser, superando así la «falacia naturalista¼. El aprecio y el respeto de la persona como un sujeto que posee un valor supremo es lo que fundamenta esta ética con base antropológica. En base a la fundamentación de la ética y la bioética en la filosofía del ser y la antropología, pero sin circunscribirse de manera exclusiva en un planteamiento bioético que desprecie los aportes de otras corrientes. Proponemos, para la carrera de medicina, un plan humanístico que incluya cursos de filosofía, antropología, ética y bioética. Este plan se trabaja fundamentalmente en los primeros años pero continúa a lo largo de las ciencias médicas y culmina, ya al final, en los cursos de clínicas. Al mismo tiempo, la propuesta va más allá del dictado de las propias materias y atraviesa toda la malla curricular. La formación integral que se busca para el estudiante de medicina no se consigue sólo con la existencia de determinadas asignaturas o créditos, sino que va avalada por el trabajo docente de todos.

Modern ethics, with its rationalism, has resulted in a dialectic between deontologism and teleologism that fragments practical reasoning into two dimensions: intuitive-transcendental and calculator-utilitarian. Inflexibility and casuistry are a consequence of this philosophy which vainly tries to give a foundation to duty. For modern philosophy, the first thing is the law, the principles from which obligations arise. Classical philosophy, on the other hand, penetrates into the nature of man and thus knows, better and better each day, the true good for the human person. It is a question of manifesting the "must be" from the "being," the ethics from the knowledge of the metaphysics of the act of being, thus overcoming the "naturalist fallacy." The appreciation and respect of the person as a subject who possesses a supreme value is what underpins this anthropologically-based ethics. Based on the foundation of ethics and bioethics in the philosophy of the being and anthropology, but not limited exclusively to a bioethical approach that disregards the contributions of other currents. For the study of medicine, we propose a humanistic plan that includes courses in philosophy, anthropology, ethics, and bioethics. This plan is mainly worked on in the early years of training but continues throughout the study of medical sciences and is completes, at the end, with the clinical courses. At the same time, the proposal goes beyond the teaching of the subjects per se and goes across the entire curriculum. The integral education that is sought for the medical student is not obtained only with the existence of certain subjects or credits, but it is guaranteed by the teaching work of all.

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Tomando como base las encuestas epidemiológicas sobre salud mental aplicadas a estudiantes de las Ciencias de la Salud de la Facultad de Medicina (Medicina, Enfermería, Obstetricia, Nutrición y Tecnología Médica) de la Universidad Nacional Mayor de San Marcos, el autor postula que existen dos formas de entender las necesidades de enseñanza de la ética: 1) Como estrategia curricular, con información teórica a través de cursos específicos; y, 2) Como soporte al desarrollo moral de la personalidad con diversas metódicas innovadoras. Apoyándose en los resultados de las encuestas citadas, que evidencian prevalencias de vida de intento suicida y conductas disociales mayores que en población general, se plantea que tal enseñanza debe planificarse para dos grupos de alumnos con diferentes necesidades: 1) Aquellos que sin patología de salud mental pueden beneficiarse con la estrategia curricular regular; y, 2) Aquellos que, presentando problemas de salud mental e indicadores de dificultades en su conducta social, deben, además, ser ayudados con técnicas orientadas a ofrecerles apoyo en su desarrollo moral. Y que este reto educativo debe ser responsabilidad de la universidad del siglo XXI, bajo la pregunta de ¿qué necesita nuestro país, profesionales de la salud que sepan ética o que se comporten éticamente?.

Based on the epidemiological surveys on mental health applied to Health Science students of the School of Medicine (Medicine, Nursing, Obstetrics, Nutrition, and Medical Technology) of Universidad Nacional Mayor de San Marcos, the author postulates that there are two ways to understand the teaching needs of ethics: 1) as a curricular strategy, with theoretical information through specific courses; and, 2) as a support to the moral development of the personality with diverse innovative methods. Based on the results of the surveys mentioned, which show lifetime prevalence of suicide attempts and dissocial behaviors greater than in the general population, it is proposed that such teaching shall be planned for two groups of students with different needs: 1) those without a mental health pathology and who can benefit from the regular curricular strategy; and, 2) those who, with mental health problems and indicators of difficulties in their social behavior, shall also be helped with techniques aimed at offering them support in their moral development. And that this educational challenge must be the responsibility of the university of the 21st century, under the question: What does our country need, health professionals who know ethics or who behave ethically?.

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OBJECTIVE: To present a narrative review of the history of bioethics in Latin America and of scientific output in this interdisciplinary field. METHODS: This was a mixed-methods study. RESULTS: A total of 1458 records were retrieved, of which 1167 met the inclusion criteria. According to the Web of Science classification, the predominant topics of study were medical ethics (n= 488), social sciences and medicine (n= 354), and environmental and public health topics (n= 279). Four themes of bioethics output in the Latin American literature have emerged: (a) issues involving the beginning and end of life, (b) ethics in human research, (c) patient-provider relationships, and (d) ethics training for health professionals. CONCLUSION: Although bioethics is a growing interdisciplinary field in Latin America, its academic impact is still very low, and programmes are highly concentrated in large urban centres in a few countries. Challenges includes the regional and international impact of local scientific output.

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Já na graduação, o futuro médico enfrenta dificuldades que vão de lidar com matérias e problemáticas novas, como enfrentar aulas com cadáveres e ­ mais complicado ­, aflições e temores de pacientes e familiares. Ao chegar à residência, por vezes, depara com assédio moral e suas consequências emocionais e profissionais ao longo de toda uma carreira. Não por acaso, foi o tema escolhido pelo Cremesp para esta publicação voltada à formação médica, em especial à residência, mas também à graduação. A obra ora lançada revisa, amplia e atualiza a versão on-line publicada pelo Cremesp em 2016, trazendo enfoques como bases históricas e sociais, relações interpessoais como causa e consequência e o reconhecimento do assédio, entre vários outros. A intenção é conscientizar a classe médica sobre a questão do assédio, sugerir e alavancar medidas para superação.

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RESUMEN

Introducción: Las nuevas tecnologías disponibles en el campo de la genética humana y médica pueden ser utilizadas, cada vez más, con fines médicos preventivos. Existe también el riesgo de su uso indebido que favorezca la discriminación y la eutanasia selectiva y minimice el papel de los condicionantes sociales en la salud de las poblaciones. Objetivo: Establecer normas éticas para garantizar que las pruebas presintomáticas en Cuba se realicen conforme a los principios éticos de respeto a la autonomía, justicia, beneficencia y no maleficencia. Métodos: Estas normas se elaboraron a partir de una propuesta discutida y consensuada en talleres nacionales con la participación de genetistas clínicos de todo el país y aprobadas por el Comité de Ética del Centro Nacional de Genética Médica y el Ministerio de Salud Pública. Resultados: Las normas aprobadas consideraron aspectos esenciales como el conocimiento sobre el alcance de la información que la prueba revelará y sus implicaciones a nivel personal y familiar, el consentimiento informado para su realización, las condiciones en que se realiza y la seguridad de sus resultados, las obligaciones médicas antes, durante y después de la realización de la prueba y lo concerniente a la privacidad y confidencialidad de la información. Conclusiones: La generalización y cumplimiento de las normas aprobadas asegura la protección a individuos y familias vulnerables, contribuye a mejorar su atención médica y a aminorar el impacto que sobre su salud, su reproducción y su vida en general, tienen las severas enfermedades para las que están en riesgo o padecen(AU)

Introduction: New technologies available in the field of human and medical genetics can increasingly be used for preventive medical purposes. There is also the risk of misuse that favors discrimination and selective euthanasia, and that minimizes the role of social determinants in the health of the populations. Objectives: To establish ethical norms to ensure that presymptomatic tests in Cuba are carried out in accordance with the principles of respect for autonomy, justice, beneficence and non-malice. Methods: These norms were elaborated from a proposal discussed and agreed upon in national workshops with the participation of clinical geneticists from all over the country and approved by the Ethics Committee of the National Center of Medical Genetics and the Ministry of Public Health. Results: The approved norms considered essential aspects such as: the knowledge about the scope of information that the test will reveal and its implications on a personal and family level, informed consent for its implementation, the conditions under which it is performed, and the safety of its results; medical obligations before, during and after the performance of the test; and all concerning to the privacy and confidentiality of the information. Conclusions: The generalization and compliance of these ethical norms ensure the protection of vulnerable individuals and families, contributes to improving their medical care and to reducing the impact on their health, their reproduction and life in general terms of the severe diseases they are at risk or suffering from(AU)

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