Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2013-05-06T13:31:16Z No. of bitstreams: 1 Neves, Nedy.pdf: 1850519 bytes, checksum: 807985f7e76df63c189543a8a9283e68 (MD5) / Approved for entry into archive by Maria Auxiliadora Lopes(silopes@ufba.br) on 2013-05-16T17:51:00Z (GMT) No. of bitstreams: 1 Neves, Nedy.pdf: 1850519 bytes, checksum: 807985f7e76df63c189543a8a9283e68 (MD5) / Made available in DSpace on 2013-05-16T17:51:00Z (GMT). No. of bitstreams: 1 Neves, Nedy.pdf: 1850519 bytes, checksum: 807985f7e76df63c189543a8a9283e68 (MD5) Previous issue date: 2005 / Este trabalho pretende fazer uma avaliação no ensino de Ética Médica nas escolas médicas de Salvador-Bahia, propondo elementos contributivos para a humanização da Medicina, através da análise das alterações introduzidas no currículo e na abordagem metodológica. A justificativa do tema é conseqüente à demanda da sociedade contemporânea que clama pela ³KXPDQL]DomR¥ dos médicos e da medicina. A evolução técnico-científica gerou uma gama de exames e procedimentos, dando um novo direcionamento à medicina científica ocidental contemporânea, afastando o médico da arte de curar. Este modelo não deve evoluir para o distanciamento da relação médico-paciente e sim para ser um auxílio diagnóstico e terapêutico. A pesquisa bibliográfica foi realizada através da utilização de livros-texto e de artigos publicados em revistas indexadas, que gerou o referencial teórico. Este material foi dividido em cinco capítulos. No primeiro capítulo foi abordada a conceituação de termos utilizados na área, como: ética, moral, deontologia, diceologia e ética médica. O segundo, foi dedicado à Bioética, com a contextualização, o histórico, os princípios e tendências. O terceiro abordou os códigos de ética e os códigos de ética médica. O quarto foi dedicado ao ensino, o ensino brasileiro a época da criação das escolas médicas e o ensino médico, com as principais reformas curriculares. O quinto capítulo, foi dedicado ao ensino de Ética Médica, através de questionamento de como, por que, quando, quem deve ensinar e como avaliar. Foi ainda realizada uma pesquisa documental e um levantamento através de análise quantitativa, utilizando questionários para os discentes e uma avaliação qualitativa, através de entrevistas para os docentes. O trabalho foi concluído com a percepção que muito ainda precisa ser transformado para que o ensino seja eficaz na transmissão de valores. / Salvador

Astract The purpose of the research aims at exlporing the relationship of organizational ethical climate, the principles of medical ethic and the performances of medical behavior and hope to get some findings that will benefit the managers and decresae the medical disputes. The major findings are summarized as follows: 1. The more health care workers pay attention to the principles of medical ethic of nonmaleficence¡Bautonomy and beneficence, the better the performances of medical behavior are. 2. The more health care workers emphasize the importance of the principle of medical ethic of justice, the less the breakout of injustice. 3. The more hospitals put emphasis on the importance of climates of law and code¡Bcaring¡Brules, the better the performances of medical behavior are 4. While Instrumental climate is obvious, the outbreak of the injustice is easier. 5. Compared with others technicians, administrants, and nutritionists, doctors and nurses feel less the climate of caring. 6. The higher the climates of law and code¡Brules that hospital managers conducted are, the lower the climates of caring and instrumental are. 7. Those who are seniors show the climates of law and code¡Brules more, while those who are older also show the climate of the rules.. 8. The invasion of autonomy in the climate of performances of medical behavior is the most serious. 9. Those health care workers with a bachelor¡¦s degree feel less the climate of law and code.

Notre recherche concerne l’éthique des soins prodigués aux personnes âgées institutionnalisées, spécialement les questions de la capacité à consentir et du traitement involontaire. Notre travail est basé sur la Théorie Fonctionnelle de l'Intégration de l'information de N.H. Anderson (1981). En ce qui concerne l'étude portant sur la capacité à consentir : 98 Hommes de la rue, 21 psychologues, 37 infirmières et 14 médecins ont jugé de la capacité de la personne âgée à faire des choix dans chacun des 50 scénarios proposés, résultants de la combinaison de trois facteurs: "type de Décision", "type de Trouble", et "Soutien social". Pour l'étude portant sur le traitement involontaire : 101 personnes du grand public, 20 psychologues, 20 infirmières et 10 médecins ont jugé de l'acceptabilité du traitement involontaire des 48 scénarios proposés, combinaison de quatre facteurs: "type de Trouble", "Décision du médecin", "Explications données au résident ", "état Cognitif". Les résultats montrent que pour les deux études, le grand public et les professionnels de santé ont intégré les facteurs de la même manière. Pour la première étude, le facteur « type de Trouble » a le plus de poids, suivi par le facteur « Soutien social ». Quatre groupes de répondants se distinguent par les poids qu'ils donnent aux différents facteurs. Concernant l'étude portant sur le traitement involontaire, le facteur le plus influent est « Explications», suivi par « Décision du médecin ». Trois groupes de répondants se distinguent en fonction des patterns de réponse. Les variables individuelles telles que l’âge, le sexe, le niveau d’éducation et l’expérience n’ont pas d’effet. L'évaluation de la capacité à consentir et l’acceptabilité du traitement involontaire sont influencées par les facteurs proposés et il apparaît qu’il existe des positions différentes face à ces questions éthiques. / Our research deals with ethical questions in gerontology, especially the capacity to consent and involuntary treatment. Our research is based on the Integration Information Theory of N.H. Anderson (1981). 98 lay people, 21 psychologists, 37 nurses and 14 physicians judged a nursing home resident’s capacity to consent on 50 scenarios combining 3 factors : “type of Decision”, “type of Problem”, “social Support”. 101 lay people, 20 psychologists, 20 nurses and 10 physicians judged the acceptability of involuntary treatment on 48 scenarios combining 4 factors : “type of Disease”, “physician’s Decision”, “Explanations”, and “Cognitive status”. Results don’t show differences between lay people and health professionals in the way they integrate the factors presented. In the first study, the factor “type of Problem” is the most significant, followed by “social Support”. 4 groups of participants distinguish themselves by the way the weigh the factors. In the second study, the factor “Explanations” is the most significant, followed by “physician’s Decision”. 3 groups of participants distinguish themselves. Individual variables like age, gender, educational level or experience have no effect. Assessment of the capacity to consent and acceptability of involuntary are influenced by the factors presented and it appears that there are different positions among the participants.

The thesis provides a comprehensive view of the "good death" and euthanasia from antiquity to the 1930s. It describes the attitudes of physicians and other scholars in different historical periods. The research is based on published sources and literature. The author examines the phenomenon in general, compares published sources and makes a comparison of the phenomenon from a historical perspective. The first part describes basic terminology related to the topic. Death and dying are viewed from the historical and ethical points of view. The second part describes the individual historical periods from antiquity to the 1930s in terms of social and cultural changes. The emphasis is placed on the opinions of philosophers, scholars and doctors about good death and euthanasia. The general view on death and euthanasia is even better illustrated by the medical care of a given period, the development of medical science and medicine. The thesis presents a theoretical base from which information for practical research of the phenomenon of death can be drawn. The examined phenomenon could be equally important and challenging for the present.

Envisager une étude de la pénalisation de l’activité médicale peut apparaître de prime abord surprenant. En effet, l’activité médicale n’est naturellement pas à même de faire l’objet d’une répression pénale dans la mesure où elle vise le rétablissement de la santé des personnes et en cela, est fondamentalement tournée vers la protection de la personne humaine. Elle partage ce fondement axiologique avec le droit pénal qui, en sus de l’ordre public, a pour vocation initiale cette même protection. Il n’est dès lors pas évident d’appréhender la pénalisation d’une branche qui, par sa nature, n’est pas soumise à une telle répression. Paradoxalement, il apparaît que l’activité médicale est en elle-même constitutive d’infractions pénales, tout acte médical étant en lui-même une atteinte au corps. Plus encore, les activités biomédicales et biotechnologiques portent parfois atteinte à l’homme, en dehors de toute nécessité médicale pour lui-même. C’est de cette ambivalence forte qu’est apparu le besoin d’une étude ayant pour objet la pénalisation de l’activité médicale. Cette recherche se propose d’évaluer et de mesurer les interactions existantes entre le droit pénal et l’activité médicale afin de porter un regard critique sur ce processus. La pénalisation a été marquée par un mouvement allant du droit pénal à l’activité médicale. Il résulte de cette analyse le constat peu satisfaisant d’une pénalisation dévoyée au contact de cette activité. Par les difficultés d’appréhension jurisprudentielle de l’acte médical, la multiplicité des normes pénales à caractère technique, l’absence de choix axiologique de politique criminelle, le droit pénal semble particulièrement inadapté et peu à même de se saisir de l’acte médical. Cette étude se propose de porter un regard renouvelé de la pénalisation de l’activité médicale, au travers des enjeux qu’elle représente. C’est alors par un mouvement contraire, allant des particularités de l’activité médicale vers le droit pénal, que ce dernier pourrait trouver un support à son renouvellement. En prenant davantage en considération les singularités techniques et éthiques de l’activité médicale, le droit pénal peut se trouver reconsidéré dans ses fonctions effective et expressive, tirant ainsi profit de l’objet mis à son contact. Ces réflexions auront pour objet de mettre en œuvre différentes pistes de réflexions et de propositions en ayant pour support les singularités de l’activité médicale. Des modifications pourront être proposées partant des techniques, notamment marquées par le risque, que le droit pénal devrait prendre en considération. De même, l’éthique médicale, par la place qu’elle accorde au consentement saura questionner la place que le droit pénal lui octroie. / It may seem surprising at first sight to consider a study about the penalization of medical activity. Actually, medical activity is not naturally in a position to be the object of a penal crackdown insofar as it aims at restoring people’s health and in that, is fundamentally focused on protecting human beings. It shares this moral base with criminal law which, in addition to public order, is initially dedicated to this very protection. Consequently, it is not that easy to comprehend the penalization of a field which is not subjected to such a crackdown by nature. Paradoxically, it appears that medical activity constitutes a criminal offence, any medical treatment or act being an infringement to a body. Moreover, biomedical and biotechnological activities can sometimes undermine human beings, even though no medical treatment is necessary. Therefore, the need of a study about the penalization of medical activity emerged because of this strong ambivalence. This research intends to assess and measure the existing interactions between criminal law and medical activity in order to have a critical look at this process. Penalization was marked by a movement going from criminal law to medical activity. The unsatisfactory result of this analysis shows a perverted penalization in contact with this activity. Because of the difficulties in apprehending the medical treatment in legal case, the multiplicity of technical penal norms, the lack of moral choice in criminal policy, criminal law seems particularly unsuited or not really able to seize the medical activity. This study intends to look at the penalization of medical activity in a new light through the stakes it represents. Criminal law could change by going the opposite way round, from the particularities of medical activity to criminal law. By taking more into account the technical and ethical distinctive features of medical activity, penal law can gain more respect in its effective and expressive functions, thus taking advantage of the object brought into contact. The scope of these thoughts will be to set up different ways of thinking, as well as some suggestions will be made, relying on the particularity of the medical activity. Some modifications will be proposed, based on various technics notably risky to be taken into consideration by the criminal law. Likewise, medical ethic, by the importance it let to the consent, will make think about the place given to it by criminal law.