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Cada etapa generalmente produce desde el punto de vista intelectual planteamientos coherentes con los discursos dominantes. En la actualidad se aboga por un enfoque sociocognitivista que cuenta con Hjorland entre sus defensores. Esta tendencia se opone a la idea de concebir "el contexto disciplinario como parte de la estructura cognoscitiva de un individuo" Hjorland, , propugna que el usuario individual sea entendido en el contexto de su disciplina.
Information science and the phenomena of information. Journal of American Society for Information Science , v. Library services in theory and context. On studying information seeking methodologically: Information Processing and Management , v. Sense-making's journey from metatheory to methodology to method: Information and Software Technology , v. Special issue on Information System Quality. Official documents. These represent the official position of the SEC on a specific subject, following the necessary deliberations..
Unofficial documents. These are used by the SEC for the continuing education of its members. They are created both by members of the Society and others and do not express the official position of the SEC..
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The original articles published in this Journal solely represent their author's position. The author must fulfill very specific requirements to be accepted as such, and the person directly responsible for the final manuscript should be clearly differentiated from the person guaranteeing its overall scientific content. The need for creating clinical practice guidelines CPG has emerged as a response to the complexity and controversial nature of medical practice.
The creation of CPGs is driven by the need to achieve several objectives 45, :. It is recommended that all CPG address some basic ethical considerations prior to their scientific or technical development. The CPG are recommendations on the correct way to proceed, based on the best available current evidence; thus, their value in healthcare should be specified 45,56 :.
The Physician and Professional Practice. The dilemma of physicians in view of the purpose of medicine. The true purposes of medicine are :. According to the above, it can be stated that currently physicians have multiple social functions 12,45, :. All this can lead to a certain crisis regarding professional identity, the development of tension within the healthcare setting, professional burnout, and becoming demoralized.
Lex artis. Risks and dangers. At all times, medicine has an obligation to define the general scientific criteria for action or "good practice," known as lex artis. This involves an assessment criterion to determine the suitability of a given medical action or professional conduct. Malpractice or poor practice is understood as not conforming to lex artis.
Accusations against physicians due to presumed mistakes, carelessness, or negligence have recently increased in Spain. Medical practice involves applying certain procedures and interventions of varying risk, which sometimes have unsatisfactory outcomes for the patient, or do not lead to cure. This can be seen as a failure or even an error due to the creation of false or unrealistic expectations.
Ethical Framework of Professional Practice. A core issue. Ethical responsibility involves respecting the ethical principles that govern the exercise of our medical profession. Legal responsibility will be fulfilled by following the given demands regarding diligence and abiding by civil, penal, and administrative law.
Bioethical principles. Since the 4th century C. This relates to the physician's competence and is defined by lex artis and criteria for indication, non-indication, and contraindication.. This relates to the capacity to make decisions and deal with factors related to our own life and death.. The term "distributive justice" is used when referring to healthcare resources.. There is a certain hierarchy within these four principles and none is absolute.
This means that there is room for exceptions in all of them, but these exceptions must always be chosen as the lesser evil, and should never become the norm. The burden of proof, or the obligation to rationally justify such a decision, lies with the person proposing the exception. Recently, an attempt to define universal "statutes of the medical profession" has been made, based on three fundamental principles 85 :.
Conscientious objection. Conscientious objection refers to that which the professional considers immoral and which the law does not prohibit due to not being defined as harmful or unjust. When physicians have a definite conscientious objection this does not mean their obligations cease, 8,9,14 as they still have the obligation to provide caring medical assistance to the patients affected by the problem, both before and after declaring their objection, and must always provide this in vital emergencies.
Similarly, there should be no double standards whereby objections are raised in the public arena but not in the private one, due to profit motives, privileges, or any other unjustifiable circumstance.. Legal Framework for Professional Practice.
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Assessing medical liability. The law states that a medical intervention is correct if it is medically indicated, has been done in line with lex artis, and was done with the consent of the patient. In Spain, the physician's liability currently falls within three procedural areas: contentious-administrative public healthcare , civil private healthcare , and criminal private and public healthcare procedures. Several elements have to come together to be able to claim medical liability via criminal or civil procedures:.
The burden of proof normally rests with the claimant. A working team should not only share knowledge and skills but also attitudes; their relationships should be governed by criteria of hierarchy and coordination. In order to delimit responsibilities within the team, two principles have been put forward 93 : trust, since a person who acts correctly should trust that the other will also do so; and division of tasks, which results from specialization and scientific progress..
The relationships between physicians and nurses have two dimensions: vertical, involving supraordinate, and subordinate relationships; and horizontal, involving the essential skills exclusive to nursing.. The Physician and the Clinical Relationship. Information and Consent are Ethical and Legal Issues. The clinical relationship between health professionals and patients or users has changed due to the legal recognition of the moral autonomy of people to make decisions regarding their own life, health, and body.
Every patient should always know who is the physician responsible for giving suitable information and coordinating clinical decisions. The obligation to inform the patient and obtain their consent constitutes an ethical and legal obligation on the part of the physician. Although there are limits to the obligation to provide information, there will always be exceptions that have to be justified.
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Informed Consent is a Verbal Process. Printed Forms. The process of informed consent should not be reduced to a signature on the printed form; rather, this should serve to support previous dialogue. In any case, the information provided should be suitable, truthful, intelligible, understandable, and adapted to the needs and demands of each patient.
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The physician always has the obligation to describe the risks typical to each procedure and any specific personal risks. The SEC has defined the risks typical to different medical activities in this specialty, identified the procedures that need written informed consent and the requirements of such forms. Confidentiality, Privacy, and Protection of Health Data.
Confidentiality is a fundamental right of the patient which has its counterpart in the following: the obligation of the physician to respect the privacy of the patient in the healthcare relationship. The obligation regarding confidentiality can be broken to prevent harm to the patient or third parties, or due to legal requirements, but whenever the physician has to do this the patient affected must be informed. The Value of the Medical Record.
The medical record is a set of documents with ethical and legal value. Health centers should guarantee the protection of health data of all the patients and users included in their records. Access to medical records is restricted to the healthcare personnel with direct responsibility for treating and caring for the patient; any other personnel are only allowed to verify certain administrative data.
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The use of computerized health data for statistical or epidemiological analysis, or inspection will be done under due legal guarantees and always anonymously. In cases of legal action against health professionals, the judge can obtain the medical record as expert evidence, while under the obligation to specify the purpose for requiring this. Biomedical Research on Human Beings. Scientific and technical advances in biomedicine should be at the service of patients and contribute to their health, development, and well-being.
Scientific evidence differentiates validated practices from empirical practices. The validation procedure consists in clinical research which should be logically justified even before being ethically justified. Every clinical research ethics committee should analyze the methodological, ethical, and legal aspects of clinical trials in human beings, in line with the principles of bioethics 18,37,70,77, :. Conflict-Resolution Scenarios. The Physician As Expert Witness. The first body to address ethical problems in healthcare institutions are the healthcare ethics committees, which are advisory and multidisciplinary.
The SEC, within its field, will support collaboration between expert witnesses in cardiology and forensic scientists regarding managing risk, evaluating medical errors and assessing physical harm. The SEC notes that the roles of expert witness and medical practitioner are incompatible regarding the same patient and encourages the cultivation of certain attitudes when making an expert witness report: objectivity, impartiality, rigor, truth, restraint, balanced critical judgment, independence, and not going beyond competence, or capability.
Distributive Justice in Healthcare. Efficiency and Equity. The debate on efficiency needs to address some core issues: the rational and sensible use of drugs, tools, and healthcare technology; the appropriate, inappropriate, or questionable use of diagnostic tests and therapies; the most suitable approach to statements of incapacity to work sick notes regarding duration, harm assessment, vital risk and associated comorbidity; or the waiting-list problem.. The SEC supports decisions that encourage equity, given that healthcare resources are finite. However, this involves: demonstrating the effectiveness of every action, considering the opportunity cost of diagnostic and therapeutic choices, affirming that the patient's utilities are the most relevant, emphasizing that "optimal is not maximal" or that "more is not always better," and assessing the different categories of care, since not all are equally effective.