January 4, 2011
Sunday, February 13, 2011
ethics and criminal responsibility the anesthesiologist
The practice of medicine helps us to more rodeos in that way it flows by itself into nothingness, to avoid any longer the final transit unknown country from whose bourn no traveler returns (forecast that, Hamlet, makes us all cowards). This feature, of collective interest, should be supervised in a specialist by the company (which should improve in the first instance, feeding conditions and labor of the impoverished population.)
How much of our criminal trial is influenced, unconsciously, by the moral legacy of antiquity?
On the other hand, the impulse toward revenge is perhaps the most primitive form of keeping memories alive ... and open wounds. More cruel, the greater is our weakness. Obviously, this impulse to indulge in the pain of others, is almost irresistible as a basis for legal penalty if, like Scott, we thought that revenge is the most exquisite delicacy.
Live, naturally, is never easy, we make the gestures that the existence calls for many reasons, the first of which is the custom, wrote Camus. We aspire to a full return to harmony with nature. To build a society without private property of men, fresh from the gods, as Seneca taught, cut off from corruption.
Doctors study medicine to save lives, but, influenced by the invisible hand that governs capitalist economy, some as merchants sell their art. And are judged not on their medical condition, but, hiding behind the mask dealers, who traded blows scalpel in random conditions of any attic: irresponsibly, from the medical point of view.
On behalf of society, doctors are aware of their Hippocratic oath, constituted Medical Arbitration Commission, which account for ethical and professional opinion on who is presumed to have exercised irresponsible medicine . Quality standards in the health service are the basis for generating the confidence necessary in the medical profession that a Medical School, for professional ethics should be the first to require and ensure. April 15 last year, the anesthesiologist Auxiliadora Rodriguez Zapata, Alice underwent epidural Indira Fernández Romero, who underwent surgery liposuction by Dr. Edgardo Morales, died of respiratory failure thistle during surgery. It is worth mentioning that Mr. Edgardo Morales fled, assuming thus an added guilt against him.
is clear that the skill of the anesthesiologist mainly in spinal anesthesia may result from paralysis to death. A jury of conscience, made up of citizens chosen at random will necessarily lay in law - whose decision, therefore, is final - found guilty Auxiliadora Rodriguez.
this jury was chosen for the defense of the accused. Instead of a special jury, which in this case would have delved into the details of professional medical accident (as, indeed, any). The sentence imposed was 12 years in prison, because the offense is classified as a conditional intent judge.
The defense argued that the cause of death was not due to anesthesia, but thrombus fat (which generally occurs when droplets of fat reach the bloodstream, through the torn vessels.) In this case, were due to start high doses of corticosteroids every 6 hours until a total of 48 hours, associated with intubation and mechanical ventilation.
Legal Medicine, however, said that one of the possible causes of death may be the epidural block. This occurs when a single dose of anesthetic is injected as a bolus, rather than fractionated doses, and no notes, wisely, that the needle has rotated in the epidural space, causing anesthesia, by penetrating the needle tip a few millimeters in front of the dura, reaches the subdural space (between the dura and arachnoid), or did not reach a blood vessel.
Symptoms of a massive spinal or systemic toxicity (by injecting the full dose of anesthesia, accidentally, in the cerebrospinal fluid) are really serious and dramatic, and occur slowly over the half an hour. The patient has trouble breathing, paralysis of limbs and chest, alterations of consciousness, low blood pressure and heart rate. The anesthesiologist during surgery, has a professional responsibility to maintain and control the heart rate, respiratory function, the patient's temperature and to replace fluids and minerals that may be lost. Should provide, also, the need to intubate the patient and provide mechanical ventilation to supply oxygen directly to the trachea, thus leading to the lungs as the patient, after anesthesia, ventilation stops by itself.
In this accident, as well as ventilation artificial, should apply via indovenosa vasodepressor drugs and atropine and CPR. Unexpected Cardiac Arrest are very resistant to cardiopulmonary resuscitation, so that the patient's fate depends entirely on the experience of the anesthesiologist and the equipment available for emergency requiring intensive care.
Currently, deaths related to anesthesia in the operating room, 100% of cases are due to human error. Therefore, in most countries engaged anesthesiologists also intensive care medicine as a medical specialty dedicated to support vital organ systems. To do so, require the provision of mechanical ventilation equipment (to assist breathing through an endotracheal tube), haemofiltration equipment (for acute renal failure), cardiovascular monitoring equipment (with arterial lines and catheters swan), indovenosas way (for parental nutrition or drug infusions), nasogastric tubes, suction pumps, drains, etc.
The private clinic, American Medical Center, where he performed cosmetic surgery, not only lacked heart monitoring equipment, but mechanical ventilation equipment. Half an hour after the patient went into arrest came in the intensive care specialists, the anesthesiologist and intensivist Yadira Bacca Becket Martin Arguello, who managed successful cardiopulmonary resuscitation. However, the time elapsed without ventilation and without proper medical care for resuscitation, was decisive for the outcome fatal.
Regardless of the causes of cardiopulmonary arrest, that a medical commission could rule (with corrective recommendations for the future), the anesthesiologist must Auxiliadora Rodriguez monitor whether there were conditions to save his patient if predictable anesthetic crisis.
When asked by a journalist about the lack of a mechanical ventilator, the anesthesiologist RodrÃguez replies:
- "How was I to know that the clinic had not Care Unit Intensive! ".
To another reporter's question. If time back down, what would you do differently in the management of this patient?, Anesthesiologist responds:
Fernando Barcenas *
; Montaigne
The practice of medicine helps us to more rodeos in that way it flows by itself into nothingness, to avoid any longer the final transit unknown country from whose bourn no traveler returns (forecast that, Hamlet, makes us all cowards). This feature, of collective interest, should be supervised in a specialist by the company (which should improve in the first instance, feeding conditions and labor of the impoverished population.)
As technology advances in support of the medical provision of accurate and timely diagnosis of different biophysical processes of our body, the medical profession, which should ensure stable parameters maintain life support, dig into the science its accountability standards. And, likewise, increases, hence their complex links with professional liability criminal law. So that the phenomenon of medical malpractice must be viewed in a social context. In the objective contradictions of modern society. Each individual responsibility for professional, needs to be approached gradually, not only from the autonomous rules of criminal law, but in a dynamic make social collective interest prevails over individual interests.
Dante, as an ideologue luminary of medieval thought, the greatest book written by man, admires the order which guarantees the payment of good and evil. In the Divine Comedy, who perverted the law of the universe by their free will, does not deserve freedom, but a just punishment. The supreme ideological criteria, which governs the rights and duties of humanity, is fundamental to a Dante-unshakable moral order. Although the sighs and tears that raises the final penalty suffered by bereaved shadows, desperate howl his second death, Dante awakens little compassion (to the point that Virgil, his guide, and saw him pale face, making human altruism greatest Italian poet and Terror to signal).
On the other hand, the impulse toward revenge is perhaps the most primitive form of keeping memories alive ... and open wounds. More cruel, the greater is our weakness. Obviously, this impulse to indulge in the pain of others, is almost irresistible as a basis for legal penalty if, like Scott, we thought that revenge is the most exquisite delicacy.
Live, naturally, is never easy, we make the gestures that the existence calls for many reasons, the first of which is the custom, wrote Camus. We aspire to a full return to harmony with nature. To build a society without private property of men, fresh from the gods, as Seneca taught, cut off from corruption.
Doctors study medicine to save lives, but, influenced by the invisible hand that governs capitalist economy, some as merchants sell their art. And are judged not on their medical condition, but, hiding behind the mask dealers, who traded blows scalpel in random conditions of any attic: irresponsibly, from the medical point of view.
On behalf of society, doctors are aware of their Hippocratic oath, constituted Medical Arbitration Commission, which account for ethical and professional opinion on who is presumed to have exercised irresponsible medicine . Quality standards in the health service are the basis for generating the confidence necessary in the medical profession that a Medical School, for professional ethics should be the first to require and ensure.
- "How was I to know that the clinic had not Care Unit Intensive! ".
To another reporter's question. If time back down, what would you do differently in the management of this patient?, Anesthesiologist responds:
- "Nothing!".
Faced with this indifference to the fate of his patient dead, one is reminded of Dante in the antepurgatorio, when Virgil showed people who were resting in the shade, behind the rock, hugging his knees negligently arms, heads down, crushed by laziness, condemned to remain outside the gate of purgatory because their lives were sluggish amid sighs.
And, out of Dante's moral and legal order, society would ask: What to do for this lady, condemned by medical malpractice to stay 12 years behind the door a prison ...?
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