Re: Presentación a la Asociación Médica Mundial Código Internacional de Ética Médica de la AMM. 

Apéndice "A"

Comentarios de la consulta de la AMM

Respuestas al proyecto en el formulario de comentarios de la consulta

Contenido

• Preámbulo
• Principios generales
• Deberes para con el paciente
• Deberes para con otros médicos y profesionales de la salud
• Deberes para con la sociedad
• Deberes de los médicos como miembros de organizaciones médicas profesionales

---

Internacional de Ética Médica de la AMM
Texto revisado actual (a abril de 2021) SUJETO A CAMBIOS

Preámbulo / Preamble

1.  The World Medical Association (WMA) has developed the International Code of Medical Ethics as a canon of ethical principles for the members of the medical profession worldwide. In concordance with the Declaration of Geneva and the WMA's entire policy apparatus, it defines and elucidates the professional duties of physicians toward their patients, other physicians and healthcare professionals, themselves, and society as a whole. The International Code of Medical Ethics should be read as a whole and each of its constituent paragraphs should be applied with consideration of all other relevant paragraphs. Consistent with the mandate of the WMA, the Code is addressed to physicians. The WMA encourages others who are involved in healthcare to adopt these principles.

 Principios generales / General principles

2.    The primary duty of the physician is to promote the health and well-being of individual patients by providing competent, compassionate care in accordance with good medical practice. The physician also has a responsibility to contribute to the health of the populations they serve and society as a whole. In providing medical care, the physician must respect the dignity and rights of the patient.

2.    El deber principal del médico es promover la salud y el bienestar de cada paciente brindándoles atención de manera competente y compasiva de acuerdo con las buenas prácticas médicas. Asimismo, el médico tiene la responsabilidad de contribuir a la salud de las poblaciones a las que atiende y a la sociedad en su conjunto. Al brindar atención médica, el médico debe respetar la dignidad y los derechos del paciente.

3.    The physician must practise with conscience, honesty, and integrity, while always exercising independent professional judgment and maintaining the highest standards of professional conduct.

3.   El médico debe ejercer su profesión con conciencia, honestidad e integridad, ejerciendo siempre un criterio profesional independiente y manteniendo los más altos estándares de conducta profesional.

• [Solo comentario del proyecto: Los Apartados 3, 6, 9, 14, 27, 30, 39 y 40 son funcionalmente interdependientes.]

4.    Physicians must not allow their professional judgment to be influenced by the possibility of benefit to themselves or their institution. They must recognise and avoid, whenever possible, or otherwise declare and manage real or potential conflicts of interest.

5.    The physician must practise medicine fairly and justly and provide care without engaging in discriminatory conduct or bias on the basis of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor. Care should be provided based on the patient's medical needs.

5.  El médico debe ejercer la medicina de manera justa y equitativa y brindar atención sin incurrir en conductas discriminatorias o prejuicios por motivos de edad, enfermedad o discapacidad, credo, origen étnico, género, nacionalidad, afiliación política, raza, orientación sexual, condición social o cualquier otro factor. Deberá brindarse atención en función de las necesidades médicas del paciente.

6.    The physician is obliged to be aware of applicable national ethical, legal, and regulatory norms and standards, as well as relevant international norms and standards. Such norms and standards must not reduce or eliminate the physician's commitment to the ethical principles set forth in this document.

6.    El médico está obligado a conocer las normas y estándares éticos, legales y reglamentarios nacionales aplicables, así como las normas y estándares internacionales pertinentes. Tales normas y estándares no deben reducir ni eliminar el compromiso del médico con los principios éticos establecidos en este documento.

• [Solo comentario del proyecto: Los Apartados 3, 6, 9, 14, 27, 30, 39 y 40 son funcionalmente interdependientes.]

7.    The physician must strive to use health care resources in a way that optimally benefits the patient, in keeping with fair, just, and prudent stewardship of the shared resources with which the physician is entrusted.

8.    When providing professional certification, physicians must only certify what they have personally verified.

9.    Physicians must take responsibility for their medical decisions and must not alter their sound professional medical judgments on the basis of instructions from non-physicians. However, physicians should consult with other health care professionals when appropriate.

9.    Los médicos deben asumir la responsabilidad de sus decisiones médicas y no deben cambiar sus sensatos criterios médicos profesionales según instrucciones de personas que no son médicos. No obstante, los médicos deberán consultar con otros profesionales de la salud cuando resulte pertinente.

• [Solo comentario del proyecto: Los Apartados 3, 6, 9, 14, 27, 30, 39 y 40 son funcionalmente interdependientes.]

10.    Physicians should offer help in medical emergencies, while considering their own safety and competence, and the availability of other options for care.

10.    Los médicos deben ofrecer ayuda ante emergencias médicas, contemplando su propia seguridad y aptitud, y la disponibilidad de otras opciones de atención.

• [Solo comentario del proyecto: “Atención” (en lugar de “tratamiento”) resulta adecuado en este contexto porque la ayuda para la que un médico es competente y puede brindar puede no ser un tratamiento o intervención médica.  Cfr. Apartados  2, 5, 14, 21]

11.    Physicians must engage in continuous learning throughout their professional lives in order to maintain and develop their professional knowledge and skills.

12.    Physicians should strive always to practise medicine in ways that are environmentally sustainable with a view to minimising environmental health risks to current and future generations.

Deberes para con el paciente / Duties to the patient

13.    A physician must always provide medical treatment with the utmost respect for human dignity and life.

13.    Un médico siempre debe brindar tratamiento médico con el máximo respeto por la dignidad y la vida humana.

14.    The physician must commit to the primacy of patient health and well-being and must offer care in the patient's best interest.

14.    El médico debe comprometerse con la prioridad de la salud y el bienestar del paciente y debe ofrecer atención el máximo beneficio del paciente.  

15.    The physician must respect the autonomy and rights of the patient, including the right to accept or refuse treatment in keeping with the patient's values and preferences.

15.    El médico debe respetar la autonomía y los derechos del paciente, incluyendo el derecho a aceptar o rechazar el tratamiento de acuerdo con los valores y preferencias del paciente.

16.    Physicians must obtain patients' voluntary informed consent prior to treatment, ensuring that patients receive and understand the information they need to make independent, well-informed decisions about their care.

16.    Los médicos deben obtener el consentimiento informado voluntario de los pacientes antes del tratamiento, garantizando que los pacientes reciban y comprendan la información que necesitan para tomar decisiones independientes y bien informadas sobre su atención.

17.    In emergencies, where the patient is not able to participate in decision making, physicians may initiate treatment in the best interests of the patient without prior informed consent.

18.    When a patient has substantially limited, undeveloped, impaired or fluctuating decision-making capacity, the physician must work with the patient's trusted surrogate, if available, to make decisions in keeping with the patient's preferences, when those are known or can reasonably be inferred, or in the patient's best interests, when the individual's preferences cannot be determined, always in keeping with the principles set forth in this Code.

19.    Physicians should be considerate of and collaborate with others, where available, who are central to the patient's care, including family members, significant others, or other health care professionals in keeping with the patient's preferences and best interest.

19.    Los médicos deben ser considerados y colaborar con otras personas, cuando estén disponibles, que resulten fundamentales para la atención del paciente, incluyendo a los miembros de la familia, otras personas importantes u otros profesionales de la salud de acuerdo con las preferencias y el máximo beneficio del paciente

• [Solo comentario del proyecto: “Atención” (en lugar de “tratamiento”) es apropiado en este contexto.  Cfr. Apartados  2, 5, 14, 21]

20.    When medically necessary, the physician must communicate with other physicians and health professionals who are involved in the care of the patient or who are qualified to assess or recommend treatment options. This communication must respect patient confidentiality and be confined to necessary information.

21.    If any aspect of caring for the patient is beyond the capacity of a physician, the physician must consult with or refer the patient to another physician or health professional who has the necessary ability.

21.    Si cualquier aspecto de la atención el paciente está más allá del capacidad de un médico, el médico debe consultar o derivar al paciente a otro médico o profesional de la salud que cuente con la aptitud necesaria.

22.    The physician must respect a patient's right to confidentiality, even after a patient has died. It may be ethical to disclose confidential information when the patient consents to it or, in exceptional cases, when disclosure is necessary to safeguard a significant and overriding ethical obligation and the patient does not or cannot consent to that disclosure. This disclosure must be limited to the minimal necessary information.

23.    If a physician is acting on behalf of or reporting to any third parties with respect to the care of a patient, the physician must inform the patient accordingly.

At the outset of an interaction, the physician must disclose to the patient the nature and extent of those commitments and must obtain prior consent for the interaction with the patient to continue.

23.    Si un médico actúa en nombre de terceros o se reporta a ellos en lo que atañe a la atención de un paciente, el médico debe informar al paciente al respecto.

Al comienzo de una interacción, el médico debe revelar al paciente la naturaleza y el alcance de esos compromisos y debe obtener previo consentimiento para que continúe la interacción con el paciente.

• [Solo comentario del proyecto: “Atención” (en lugar de “tratamiento”) es apropiado en este contexto.  Cfr. Apartados  2, 5, 14, 21]

24.    Physicians must refrain from intrusive advertising and marketing and ensure that all information used by them in advertising and marketing is correct and not misleading. Physicians may not participate in advertising or marketing of products related to their professional activity.

25.    The physician should not allow commercial, financial, or other conflicting interests to take precedence over the physician's professional judgment.

26.    When providing medical consultation or treatment in the form of telemedicine, the physician must ensure that this form of communication is medically justifiable and that the necessary medical care is guaranteed, particularly through the manner in which diagnostic assessment, medical consultation, treatment and documentation are carried out. The physician is also obligated to inform the patient about the particularities of receiving medical consultation and treatment via communications media. Wherever helpful, physicians must aim to provide medical consultation and treatment to patients through direct, personal contact.

27.    Physicians have an ethical obligation to minimise disruption to patient care. Conscientious objection must only be considered if the individual patient is not discriminated against or disadvantaged, the patient's health is not endangered, and undelayed continuity of care is ensured through effective and timely referral to another qualified physician.*

* This paragraph will be debated in greater detail at the WMA's dedicated conference on the subject of conscientious objection in 2021 or 2022. However, comments on this paragraph are also welcome at this time.

27.    Los médicos en particular tiene la obligación ética de minimizar la interrupción de la atención al paciente. La objeción de conciencia solo debe considerarse si ese paciente en particular no es discriminado o desfavorecido, si la salud del paciente no está en peligro y si la continuidad sin demoras de la atención está garantizada mediante la derivación efectiva y oportuna a otro médico calificado.

* Este apartado se debatirá con mayor detalle en la conferencia exclusiva de la AMM sobre el tema de la objeción de conciencia en 2021 o 2022. No obstante, los comentarios sobre este apartado también son bienvenidos en este momento.

28.    Appropriate professional boundaries must be maintained. Physicians must not engage in a sexual relationship with a current patient and must never engage in abusive or exploitative relationships with a patient.

29.    In order to provide care of the highest standard, physicians must attend to their own health, well-being and abilities. This includes seeking appropriate care to ensure that they are able to practise safely.

29.    Para poder brindar una atención del más alto nivel, los médicos deben ocuparse de su propia salud, bienestar y habilidades. Esto incluye buscar la atención adecuada para garantizar que puedan ejercer la profesión de forma segura.

• [Solo comentario del proyecto: “Atención” (en lugar de “tratamiento”) es apropiado en este contexto.  Cfr. Apartados  2, 5, 14, 21]

Deberes para con otros médicos y profesionales de la salud / Duties to other physicians and health professionals

30.    The physician must engage with other physicians and health professionals in a respectful and collaborative manner. Physicians must also ensure that ethical principles are upheld when working in teams.

30.    El médico debe relacionarse con otros médicos y profesionales de la salud de manera respetuosa y colaborativa. Los médicos también deben asegurarse de que se respeten los principios éticos cuando trabajan en equipo.

• [Solo comentario del proyecto: Los Apartados 3, 6, 9, 14, 27, 30, 39 y 40 son funcionalmente interdependientes.]

31.    The physician should respect colleagues' patient-physician relationships and not intervene unless needed to protect the patient from harm. This should not prevent the physician from recommending alternative courses of action considered to be in patients' best interests.

32.    Physicians should report conditions or circumstances which impede them from providing care of the highest standards, including violence against physicians and other health personnel, inappropriate working conditions, and any other unsustainable stress factors.

32.    Los médicos deben informar las condiciones o circunstancias que les impiden brindar una atención del más alto nivel, incluyendo la violencia contra los médicos y demás personal de salud, condiciones de trabajo inadecuadas y cualquier otro factor de estrés insostenible.

• [Solo comentario del proyecto: "Care" (rather than "treatment") is appropriate in this context. Cf Paragraphs 2, 5, 14, 21]

33.    Due respect should be granted to teachers and students of medicine and other health professionals.

Deberes para con la sociedad / Duties to society

34.    Physicians must support fair and equitable provision of health care. This includes addressing inequities in health and care, the determinants of those inequities, as well as violations of the rights of patients and health care professionals.

34.    Los médicos deben apoyar la prestación justa y equitativa de la asistencia sanitaria. Esto incluye abordar las inequidades en la salud y la atención, los determinantes de tales inequidades, así como las violaciones a los derechos de los pacientes y los profesionales de la salud.

• [Solo comentario del proyecto: "Care" (rather than "treatment") is appropriate in this context. Cf Paragraphs 2, 5, 14, 21]

35.    Physicians play an important role in matters relating to the health and safety of the public, health education and health literacy. In fulfilling this responsibility, physicians should be prudent in discussing new discoveries, technologies, or treatments in non-professional, public venues and should ensure that their statements are scientifically accurate.

Physicians should be especially careful to distinguish in their public comments between evidence-based scientific information and their own personal opinions.

35.    Los médicos desempeñan un papel importante en cuestiones relacionadas con la salud y la seguridad del público, la educación sanitaria y la alfabetización sanitaria. En el cumplimiento de esta responsabilidad, los médicos deben ser prudentes al debatir nuevos descubrimientos, tecnologías o tratamientos en lugares públicos no profesionales y deben garantizar que sus declaraciones sean científicamente precisas.

Los médicos deben tener especial cuidado en distinguir en sus comentarios públicos entre información científica basada en pruebas y sus propias opiniones personales.

36.    Physicians should avoid acting in such a way as to weaken public trust in the medical profession. To maintain that trust, physicians must hold themselves and fellow physicians to the highest standards of professional conduct and be prepared to report unethical or incompetent behaviour.

37.    Physicians should share their medical knowledge and expertise for the benefit of patients and the advancement of healthcare.

38.    Physicians have a duty to support the conduct of scientifically sound medical research in keeping with the ethical principles of the Declaration of Helsinki.

Deberes de los médicos como miembros de organizaciones médicas profesionales / Duties of the physician as members of professional medical organisations

39.    As members of professional medical organisations, physicians shall follow, protect, and promote the ethical principles of this code. They shall help prevent national or international ethical, legal, or regulatory requirements that undermine any of the duties set forth in this document.

39.    Como miembros de organizaciones médicas profesionales, los médicos deben seguir, proteger y promover los principios éticos de este código. Ayudarán a prevenir requisitos éticos, legales o reglamentarios nacionales o internacionales que socaven cualquiera de los deberes establecidos en este documento.

• [Solo comentario del proyecto: Los Apartados 3, 6, 9, 14, 27, 30, 39 y 40 son funcionalmente interdependientes.]

40.    As members of professional medical organisations, it is the task of physicians to support fellow members in upholding the responsibilities set out in this code and to take measures to protect them from undue influence, from violence and from oppression.

40.    Como miembros de organizaciones médicas profesionales, es tarea de los médicos apoyar a sus compañeros en el cumplimiento de las responsabilidades establecidas en este código y tomar medidas para protegerlos de influencias indebidas, violencia y opresión.

• [Solo comentario del proyecto: Los Apartados 3, 6, 9, 14, 27, 30, 39 y 40 son funcionalmente interdependientes.]