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RATIONALE: In the context of a major health crisis, health professionals must first compare patients' recovery prospects, thus giving priority to the goal of saving the greatest number of lives. AIMS AND OBJECTIVES: Critically evaluate a protocol for allocation of scarce intensive care units (ICU), which the authors proposed at the onset of the COVID-19 pandemic and originally published in two Brazilian newspapers; and compare that protocol with similar proposals, particularly with 2 successive protocols issued by the Brazilian Critical Care Association. The main objective is to highlight the advantages of the authors' approach and discuss some criticisms that has been levelled against the proposed protocol after its original publication in 2020. METHOD: Comparative analysis of 3 different protocols (the authors' proposed protocol and 2 successive protocols issued by the Brazilian Critical Care Association) with regard to ethical principles. RESULTS: The main objective of a healthcare system is to ensure a fair patient triage process when it is impossible to grant admission to all patients in need of treatment. Decision-making regarding the impartial prioritization of ICU admissions must be based primarily on clinical criteria. The Sequential Organ Failure Assessment (SOFA) is, for ethical and technical reasons, a useful tool for clinical assessments of patients. Based on three ranges of SOFA scores, patients can be classified into a "high", a "medium", and a "low" priority group. In the case of ties, the life cycle principle must be the tiebreaker. If the tie persists, a draw must be used. CONCLUSION: The authors' proposed protocol has advantages over the other two protocols due to its greater practicality and capacity to account for egalitarian and consequentialist principles simultaneously. It aims at saving as many lives as possible within the constraints of fairness. Furthermore, the proposed protocol avoids discrimination against people with disabilities without, at the same time, promoting discrimination against the elderly.

RESUMO

RESUMEN: Se considera y valora el concepto de paciente como persona, tanto en el lenguaje común, en el lenguaje médico y de la persona enferma. Se exponen las visiones de la persona como paciente; la visión mecánica y las visiones humanistas: la fenomenológica, la noción de persona de Cassell, el yo y el otro de Tauber, la visión bio-psico-social de Engel y la medicina centrada en la persona. Humanizar la medicina para resolver la crisis actual de la atención médica.

ABSTRACT: The concept of the patient as a person is considered and valued, both in common language, medical language and of the sick person. The visions of the person as a patient are exposed; the mechanical vision and the humanistic visions: phenomenological, Cassell person notion, Tauber self and the other, Engel bio-psicho-social and the person centered medicine. Humanize medicine to solve the current health crisis.

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Se revisa inicialmente la axiología filosófica: concepto, desarrollo histórico y teorías axiológicas. Se trata el tema de valores: definición, clasificación y jerarquización. Se ingresa a la axiología médica, concepto y desarrollo histórico. Se revisa el sistema de valores de la profesión médica y sus funciones: valores morales, cognitivos y culturales.

Philosophical axiology is initially reviewed: concept, historical development and axiological theories. It deals with the issue of values: definition, classification and hierarchy. We enter to medical axiology, concept and historical development. The value system and functions of the medical profession are reviewed: moral, cognitive and cultural values.

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Puede decirse que el pensamiento filosófico y la medicina surgieron juntos en los inicios de la civilización griega, cuna de la cultura occidental. En el presente ensayo, se hace una revisión histórica desde la filosofía Pitagórica hasta los paradigmas de Kuhn, mostrando autores y obras de la antigüedad, modernidad y época contemporánea, que ilustran la influencia recíproca entre la filosofía y la medicina.

It is possible to say that philosophical thought and medicine emerged together at the beginning of the Greek civilization, cradle of western culture. In the present trial, a historical review is made, from Pythagorean philosophy to Kuhns' paradigms, showing authors and works from antiquity, modernity and contemporary epoch, illustrating the reciprocal influence between philosophy and medicine

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La filosofía de la medicina es un importante campo de estudio que se ocupa de temas y problemas filosóficamente relevantes en el estudio y práctica de la medicina. Este ensayo es una primera aproximación, ubicándola en el contexto histórico desde tiempos hipocráticos hasta la medicina contemporánea. Se exponen intentos de delimitación del campo específico, desde criterios de médicos y filósofos de la antigüedad hasta el concepto actual de la primacía de la relación médico-paciente, abarcando áreas fundamentales como ontología, epistemología y ética. Se destaca el debate desde la década de los 70, mostrando las tendencias actuales negativa, amplia y específica sobre su posibilidad como disciplina específica, culminando con la presentación de los cuatro modelos de filosofía de la medicina propuestos por Edmund Pellegrino.

Philosophy of medicine is an outstanding study field concerning philosophically relevant subjects and problems in medical study and practice. This paper is a first approach, showing the historical context since Hippocratic to present times. Delimitation attempts for specifying the field are shown, from ancient physicians and philosopher's criteria to present primacy of the physician-patient relationship, covering fundamental areas as ontology, epistemology and ethics. Present debate starting the seventies is pointed out, displaying negative, broad and specific tendencies for its consideration as a specific discipline, concluding with the four philosophy of medicine models proposed by Edmund Pellegrino.

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Se explica el origen de los términos cirugía plástica y rinoplastia, así como los inicios de la especialidad y de esta cirugía nasal. Se exponen cuáles fueron las necesidades que atendieron y qué lugar ocuparon la reparación y la reconstrucción en la historia y la filosofía de la medicina. La cirugía plástica se instaló como la disciplina quirúrgica encargada de buscar la recuperación de la identidad perdida. (AU)

The origin of the terms of "plastic surgery" and "Rhinoplasty" is explained, as well as the beginning of the specialty and this nasal surgery. It explains what his need was and how he filled that gap, the repair and reconstruction in the history and philosophy of medicine. It was installed as the surgical discipline in charge of seeking the recovery of the lost identity. (AU)

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BACKGROUND: Motivation is a crucial and widespread theme within medicine. From clinical to surgical scenarios, acquiescence in taking a pill or coming to a consultation is imperative for medical treatment to thrive. The "decade of the brain" gave practitioners substantial neuroscientific data on human behavior, helped to explain why people do what they do and created the concept of "motivated brain". Findings from empirical psychology stratified motivation into stages of change, which became more complex over the decades. This research seeks to improve the understanding of how people make decisions about their health, and how to better understand strategies and techniques to help them resolve ambivalence in an effective goal-oriented way. METHODS: We establish a dialogue with Ricoeur's phenomenology of the will in order to understand the meaning of these scientific findings. Starting from Husserlian phenomenology, Paul Ricoeur developed his thoughts away from transcendental idealism, through emancipating the intentional structures of the will from the realm of perception. RESULTS: Through introducing the concepts of the voluntary and the involuntary, Ricoeur deviated from Cartesian dualism, which renders the body as an object body, a target of natural vicissitudes. The new dualism of the voluntary and the involuntary is dealt with by reference to what Ricoeur called the central mystery of incarnate existence, which considers man "double in humanity, simple in vitality". This duality makes it possible to consider the brain to be the natural organ of behavior in the human body, and to use empirical psychology as a path to escape from shallow subjectivations of concepts. CONCLUSIONS: Paul Ricoeur's simplicity (or unity) of existence provides an invitation for medicine to rethink some of its philosophical assumptions, such that patients can be considered to be autonomous subjects with authorial life projects. Ricoeurian anthropology has a deep ethical impact on how medicine should use technology, which arises from empirical psychology findings. The usage of this new knowledge also needs to be thoroughly inspected, since it shifts the social role of medical science.

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La filosofía de la medicina es un interesante campo de estudios que se ocupa de temas y problemas filosóficamente relevantes en la práctica e investigación en medicina. Sin embargo, a pesar de que en otras latitudes la filosofía de la medicina goza de reconocimiento, en Colombia ha recibido poca atención, en particular porque el auge de la bioética ha opacado otro tipo de reflexiones sobre el quehacer médico. En este artículo, partiendo de una mirada general sobre la formación del campo, se argumenta que una filosofía crítica de la medicina debe ser promovida como reflexión amplia y crítica sobre la génesis y posibles salidas a la crisis que el sistema de salud y las profesiones de la salud han experimentado en Colombia en las últimas dos décadas. Esta filosofía crítica de la medicina ha de contribuir entonces a formar médicos y profesionales de la salud para ser capaces de transformar el éthos de sus propias profesiones y el de los servicios de salud.

Philosophy of Medicine is an interesting field of study concerned with issues and problems that are philosophically relevant in practice and research in Medicine. However, although Philosophy of Medicine enjoys recognition in other latitudes, in Colombia it has received little attention, in particular, because of the rise of bioethics, which has overshadowed other kinds of reflections on the medical task. In this paper, departing from an overview about the formation of the field, it is argued that a Critical Philosophy of Medicine should be promoted as a deep and critical reflection on the genesis and possible way outs to the crisis that the healthcare system and the medical profession have experienced in Colombia in the last two decades. A Critical Philosophy of Medicine must then contribute to training physicians and health professionals to be able to transform the ethos of their professions as well as of the health care services.

A filosofia da medicina é um campo excitante de estudos que lidam com temas e problemas filosoficamente relevantes na prática e investigação em medicina. No entanto, embora em outras instâncias da filosofia da medicina tem reconhecimento, na Colômbia tem recebido pouca atenção, especialmente porque o auge da bioética tem ofuscado outro tipo de reflexões sobre o do-que-fazer médico. Neste artigo, a partir de uma visão geral sobre a formação do campo, argumenta-se que uma filosofia crítica da medicina deve ser promovida como reflexão ampla e crítica sobre a gênese e possíveis soluções para a crise que o sistema de saúde e as profissões da saúde têm experimentado na Colômbia nas últimas duas décadas. Esta filosofia crítica da medicina deve, então, contribuir a formar médicos e profissionais da saúde para serem capazes de transformar o ethos de suas próprias profissões e o dos serviços de saúde.

RESUMO

RATIONALE, AIMS AND OBJECTIVES: The nature of the relationship between bipolar disorder and borderline personality disorder has been an intense field of debate in the last two decades. Current diagnostic classifications approach this complex phenomenon using syndromatic definitions based on presence or absence of a restricted set of signs or symptoms that have demonstrated low specificity. One of the several utilities of the phenomenological method in psychiatry is to complement the clinical panorama, helping in the process of identifying potential differences between two separated clinical syndromes. The main objective of this publication is to explore one particular clinical difference between these two conditions - that is, the experience of self-continuity and time perception. METHODS: the argument explored in this paper is based on previous second-person or phenomenological accounts of sufferers of both conditions. RESULTS AND CONCLUSIONS: Whereas borderline personality disorder patients tend to experience only the present moment, referring frequent difficulties of drawing experiences of the past in order to determine their own future, bipolar disorder patients are constantly worried about the contradictions in their past experiences and the latent risk of losing control of themselves in future episodes of their disease. This contrast should be, however, corroborated in future research comparing directly the two groups in terms of the continuity of the self and their temporal structures.

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Se analizan las distintas vertientes y los objetivos de la formación en Humanidades Médicas en distintos ámbitos, con la finalidad de concienciación sobre la necesidad de la creación de una estructura docente con esa finalidad en la Universidad de la República bajo la égida de la Facultad de Medicina.

Analysis of the different aspects and the training objectives in the field of Medical Humanities in various settings, to raise awareness on the need for creating a teaching structure for that purpose at the University of the Republic, under the umbrella of the School of Medicine.