RESUMO
In most hospitals in Puerto Rico the dying process of terminally ill patients is inappropriately prolonged. And this occurs often without the patient's consent and in violation of basic ethical principles. Three erroneous beliefs are prevalent: 1--That withdrawing life support therapy is morally or legally different from not starting it. 2--That there is a moral and legal difference between appropriate acts and appropriate omissions. 3--That good medical practice is determined by the courts instead of the medical profession. Institutional policies are not in harmony with contemporary medical ethics. To avoid possible legal entanglements medical institutions permit their faculties to prolong the suffering of patients in violation of two basic moral principles: nonmaleficence and respect for autonomy. An illustrative case provides a philosopher and a moral theologian the opportunity to analyze the applicable moral principles. A professor of jurisprudence reviews statutes evolved at the State and Federal level that support the rights of patients and their families to refuse unwanted treatments. Medical faculties must ensure that institutional policies do not violate their professional ethics. The medical profession and the citizenry at large should lobby for the passage of statutes in Puerto Rico which clearly validate the necessary harmony between medical ethics and the law
Assuntos
Humanos , Masculino , Idoso , Ética Médica , Princípios Morais , Ordens quanto à Conduta (Ética Médica) , Consentimento do Representante Legal , Consentimento do Representante Legal/legislação & jurisprudência , Futilidade Médica , Ordens quanto à Conduta (Ética Médica)/legislação & jurisprudência , Porto Rico , Religião e MedicinaRESUMO
In most hospitals in Puerto Rico the dying process of terminally ill patients is inappropriately prolonged. And this occurs often without the patient's consent and in violation of basic ethical principles. Three erroneous beliefs are prevalent: 1--That withdrawing life support therapy is morally or legally different from not starting it. 2--That there is a moral and legal difference between appropriate acts and appropriate omissions. 3--That good medical practice is determined by the courts instead of the medical profession. Institutional policies are not in harmony with contemporary medical ethics. To avoid possible legal entanglements medical institutions permit their faculties to prolong the suffering of patients in violation of two basic moral principles: nonmaleficence and respect for autonomy. An illustrative case provides a philosopher and a moral theologian the opportunity to analyze the applicable moral principles. A professor of jurisprudence reviews statutes evolved at the State and Federal level that support the rights of patients and their families to refuse unwanted treatments. Medical faculties must ensure that institutional policies do not violate their professional ethics. The medical profession and the citizenry at large should lobby for the passage of statutes in Puerto Rico which clearly validate the necessary harmony between medical ethics and the law.
Assuntos
Ética Médica , Princípios Morais , Ordens quanto à Conduta (Ética Médica) , Consentimento do Representante Legal , Idoso , Humanos , Masculino , Futilidade Médica , Porto Rico , Religião e Medicina , Ordens quanto à Conduta (Ética Médica)/legislação & jurisprudência , Consentimento do Representante Legal/legislação & jurisprudênciaRESUMO
Examinamos 37 pacientes diagnosticados de lepra estudiando sus lesiones uveales cristalinas y esclerales. De ellos 31 eran formas lepromatosas, 2 borderline lepromatosas , 2 borderline tuberculoide y 2 tuberculoides. En 6 casos no encontramos lesiones de ningún tipo. En los restantes casos observamos una disminución de la agudeza visual directamente relacionada con la duración de la enfermedad. Las uveites crónicas indolentes fueron la causa más importante de ceguera, de las mismas fueron signos típicos la atrofia iridiana peripupilar, los precipitados queráticos, las sinequias posteriores y la miosis. Un número sorprendentemente elevado de pacientes presentaban ptisis bulbi uni o bilateral por atrofia del cuerpo ciliar. Las lesiones esclerales estuvieron representadas por escleritis, episcleritis en los casos agudos. La ectasia y adelgazamiento escleral aparecieron como secuelas de la anteriores en menor número de pacientes. No hemos encontrado lesiones funduscópicas.
Assuntos
Hanseníase/complicaçõesRESUMO
Se presenta un caso de lepra dimorfa en un varón de 13 años, con múltiples lesiones cutáneas, placas, nódulos, pápilas, alopecia y neuropatía periférica. Bacilospopía positiva. Se le clasifica com BT con "downgrading reaction". A los 3 años del control persisten escasas lesiones, la bacteriología es negativa. Se hacen consideraciones sobre la inestabilidad y la frecuente evolúción sin terapéutica adecuada hacia el polo lepromatoso.