Goldim Josté Roberto, Raymundo Márcia M, Fernandes Márcia Santana, Lopes Maria Helena Itaqui, Kipper Délio José, Francisconi Carlos Fernando
Bioethics and Science Ethics Research Laboratory of the Hospital de Clínicas de Porto Alegre.
J Int Bioethique. 2008 Mar-Jun;19(1-2):181-92, 207. doi: 10.3917/jib.191.0181.
Since its beginning, Bioethics has been related to medical decision making. In health settings, difficult dilemmas, critical situations, controversial decisions are problems that clinical Bioethics reflects on. Institutional Ethics Committees is a general and ambiguous denomination to many different activities. In Brazilian hospitals, we have three different kinds of ethics and bioethics committees: Medical Ethics Committees, Research Ethics Committees and Clinical Bioethics Committees. The first implemented committees were the Medical Ethics Committees, whose objective is to evaluate professional ethics conflicts. These committees were proposed by the Conselho Federal de Medicina (Brazilian Medicine Council). In 1988, the Brazilian government, through the Conselho Nacional de Saude (Brazilian National Health Council) proposed the first research guidelines: Resolucao 01/88, updated in 1996 by Resolucao 196/96. One of these guidelines created the Research Ethics Committees. The first one was created in the Hospital Sao Lucas and the second in the Hospital de Clinicas de Porto Alegre, both in Porto Alegre, Rio Grande do Sul. In 1993, the Hospital de Clinicas de Porto Alegre created the first Brazilian Clinical Bioethics Committee. A Clinical Bioethics Committee can be defined as an interdisciplinary group of health professionals and other persons, whose objective is to provide consultancy on ethical questions and suggest institutional ethical guidelines, in a transdisciplinary perspective. In healthcare institutions, especially in hospitals, Clinical Bioethics Committees can help different segments in critical decision-making that involves ethical, moral, legal or social issues. The activities of a Clinical Bioethics Committee can be reactive or proactive. Consultancy is the typical reactive activity. Clinical Bioethics rounds are the example of proactive activity. In this study, we will present two different Brazilian experiences in Clinical Bioethics Committees: Hospital Sao Lucas and Hospital de Clinicas de Porto Alegre.
自创立之初，生物伦理学就与医疗决策相关。在医疗环境中，艰难的困境、危急情况、有争议的决策都是临床生物伦理学所思考的问题。机构伦理委员会是对许多不同活动的一个笼统且模糊的称谓。在巴西的医院里，我们有三种不同类型的伦理和生物伦理委员会：医学伦理委员会、研究伦理委员会和临床生物伦理委员会。最早设立的委员会是医学伦理委员会，其目的是评估职业道德冲突。这些委员会是由巴西医学委员会提议设立的。1988年，巴西政府通过巴西国家卫生委员会提出了首批研究指南：第01/88号决议，1996年由第196/96号决议更新。其中一项指南设立了研究伦理委员会。第一个研究伦理委员会在圣卢卡斯医院成立，第二个在南里奥格兰德州阿雷格里港的临床医院成立。1993年，阿雷格里港临床医院成立了巴西第一个临床生物伦理委员会。临床生物伦理委员会可被定义为一个由卫生专业人员和其他人员组成的跨学科团体，其目标是以跨学科的视角就伦理问题提供咨询并提出机构伦理指南。在医疗机构，尤其是医院，临床生物伦理委员会可以在涉及伦理、道德、法律或社会问题的关键决策中帮助不同部门。临床生物伦理委员会的活动可以是被动反应式的或主动积极式的。咨询是典型的被动反应式活动。临床生物伦理查房是主动积极式活动的例子。在本研究中，我们将介绍巴西临床生物伦理委员会的两种不同经验：圣卢卡斯医院和阿雷格里港临床医院。
