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      El consentimiento informado como un continuo narrativo Translated title: Informed consent as a narrative continuum Translated title: El consentiment informat com un continu narratiu

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          Abstract

          Resumen El consentimiento informado (CI) suele entenderse como una declaración, comúnmente escrita, con la que una persona acepta, de manera libre e informada, someterse a un cierto procedimiento médico. Recientemente, Tunzi et al. (2021) han propuesto un nuevo modelo de CI para la atención médica primaria, al que llaman "el consentimiento continuo" (CC), el cual ofrece una alternativa al estado actual del modo en que se obtiene el CI. Ellos sostienen que su modelo "honra la autonomía del paciente, satisface las obligaciones legales [del personal médico] y mejora el cuidado del paciente de una manera que es tanto transparente como pragmática" (Tunzi et al. 2021:35). Me propongo hacer una revisión crítica de su propuesta y argumentar que este modelo continuo puede reforzarse enmarcándolo dentro de un enfoque narrativo y concibiendo a la relación médico paciente (RMP) bajo dicho enfoque.

          Translated abstract

          Abstract Informed consent (IC) is generally understood as a statement, usually written, by which a person freely and informedly agrees to undergo a certain medical procedure. Recently, Tunzi et al. (2021) have proposed a new model of IC for primary medical care, which they call "the consent continuum" (CC), which offers an alternative to the current state of how IC is obtained. They argue that their model "honors patient autonomy, meets legal obligations, and improves patient care and satisfaction in a manner that is both transparent and pragmatic" (Tunzi et al. 2021:35). I propose to critically review their proposal and argue that this continuum model can be strengthened by framing it within a narrative approach and conceiving of the physician-patient relationship (PMR) under such an approach.

          Translated abstract

          Resum El consentiment informat (CI) sol entendre's com una declaració, comunament escrita, amb la qual una persona accepta, de manera lliure i informada, sotmetre's a un cert procediment mèdic. Recentment, Tunzi et al. (2021) han proposat un nou model de CI per a l'atenció mèdica primària, al qual anomenen "el consentiment continu" (CC), el qual ofereix una alternativa a l'estat actual de la manera en què s'obté el CI. Ells sostenen que el seu model "honra l'autonomia del pacient, satisfà les obligacions legals [del personal mèdic] i millora la cura del pacient d'una manera que és tant transparent com pragmàtica" (Tunzi et al. 2021:35). Em proposo fer una revisió crítica de la seva proposta i argumentar que aquest model continu pot reforçar-se emmarcant-lo dins d'un enfocament narratiu i concebent a la relació metge pacient (RMP) baix dit enfocament.

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          Bystander intervention in emergencies: diffusion of responsibility.

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            How doctors and patients discuss routine clinical decisions. Informed decision making in the outpatient setting.

            To characterize the informed consent process in routine, primary care office practice. Cross-sectional, descriptive evaluation of audiotaped encounters. Offices of primary care physicians in Portland, Oregon. Internists (54%) and family physicians (46%), and their patients. Audiotapes of primary care office visits from a previous study of doctor-patient communication were coded for the number and type of clinical decisions made. The discussion between doctor and patient was scored according to six criteria for informed decision making: description of the nature of the decision, discussion of alternatives, discussion of risks and benefits, discussion of related uncertainties, assessment of the patient's understanding and elicitation of the patient's preference. Discussions leading to decisions included fewer than two of the six described elements of informed decision making (mean 1.23, median 1.0), most frequent of these was description of the nature of the decision (83% of discussion). Discussion of risks and benefits was less frequent (9%), and assessment of understanding was rare (2%). Discussions of management decisions were generally more substantive than discussions of diagnostic decisions (p = .05). Discussions leading to clinical decisions in these primary care settings did not fulfill the criteria considered integral to informed decision making. Physicians frequently described the nature of the decision, less frequently discussed risks and benefits, and rarely assessed the patient's understanding of the decision.
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              The constitution of selves

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                Author and article information

                Journal
                bioetica
                Revista de Bioética y Derecho
                Rev. Bioética y Derecho
                Observatori de Bioètica i Dret - Cátedra UNESCO de Bioética (Barcelona, Barcelona, Spain )
                1886-5887
                2022
                : 54
                : 83-102
                Affiliations
                [1] orgnameUniversidad Autónoma de Zacatecas Mexico
                Article
                S1886-58872022000100083 S1886-5887(22)00005400083
                10.1344/rbd2021.54.36542
                04147d20-fa01-43b3-9afa-c409b8d9256a

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 21 September 2021
                : 25 January 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 20
                Product

                SciELO Spain

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                Sección General

                informed consent,continuous consent,narrative approach,process,patient-physician relationship,consentimiento informado,consentimiento continuo,enfoque narrativo,proceso,relación médico paciente,consentiment informat,consentiment continu,enfocament narratiu,procés,relació metge paciente

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