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Background: The educational model adopted by the Universidad Nacional Autónoma de México (UNAM) Faculty of Medicine is constructivist; it is a model based on competence development. It aims to provide learning environments that incorporate real activities (it helps the students to develop social negotiation skills, as part of their integral learning; it encourages them to take a critical and reflexive approach; and it is also a student-centered model). However, many challenges arise when this model is implemented in the context of hospital environments. Therefore, our aim was to analyse the hospital as an hermeneutical community and as a power relations scenario, contrary to the constructivist model. Methods: In the analysis of a conflict between a chief of a medical department and an undergraduated medical intern, we use Miranda Fricker's categories discriminatory epistemic injustice, and testimonial injustice, as well as Foucault's power relationships and knowledge. Results: The program implementation is placed in the context of power relations and different disciplinary methods that could affect the training process of the students, whose educational background belongs to the constructivist model. This in part is due to the existence of informal normative structures that are hidden in the process of medical knowledge construction at the hospital scenario. Conclusion: Practices of epistemic discriminatory injustice in the hospital environment increase vulnerability conditions for medical students in their education process. [ABSTRACT FROM AUTHOR]

In this research we focus on the medical evangelist Levi B. Salmans, and The Good Samaritan sanitarium. Doctor Salmans lived in Mexico for about 50 years (1885-1935). During the first part of his stay, he was devoted to found churches and Methodist schools. However, from 1891 he took a turn in his career by founding dispensaries in different towns of Guanajuato to create, in 1899, the private charity association for the sick and infirm The Good Samaritan. His intense, intellectual, and practical work led him to create health journals, to train nurses, and to promote physiotherapies in accordance with the science advances of that time. By itself, this research shows that the history of medicine in Mexico still has long way to go and that Protestant communities, in favor of modernity and scientific knowledge, took a big part in shaping the history of this discipline in Mexico. [ABSTRACT FROM AUTHOR]

From the second half of the 19th century, health disciplines went through an institutional and professional restructuring, which progressively altered the guild order that had characterized them to that point. In the case of Pharmacy, this process implied the generation of officially recognized spaces, as the chairs of Pharmacy and Medical Substance, founded during the Establecimiento de Ciencias Médicas (Establishment of Medical Sciences) (1833). In those spaces it was sought to institutionalize knowledge and modern practices related to Pharmacy. In this work we look over the first academic experience of the pharmaceutical community in that new space of instruction, based on the records belonging to the students enrolled in the Establecimiento de Ciencias Médicas from 1833 to 1865, year of the enrollment of the last generation. The information contained in those 163 records displays the way the pharmaceutical field was transformed, after the aforementioned restructuring. The reader will notice the diverse normativity, which regulated the joining of pharmacists to academic life (of which, until then, they were excluded). He will also realize how, among the first students enrolled in the Establecimiento de Ciencias Médicas, said normativity was broke in order to adapt it to the known ways of students and professors. Progressively, the guild instruction would be ousted by the institutional instruction (for example, the years of practice in the drugstores were rejected), so that the guild ways of teaching were changing to turn the pharmacist into an individual of institutional instruction. Desde la segunda mitad del siglo XIX, las disciplinas de la salud atravesaron por una reestructuración institucional y profesional que progresivamente alteró el orden gremial que las agrupaba. Para el caso de la Farmacia, el proceso implicó la generación de espacios oficialmente reconocidos, como las propias cátedras de Farmacia y de Materia Médica, fundadas en el Establecimiento de Ciencias Médicas (1833). En esos espacios se buscó institucionalizar los saberes y las prácticas modernas relacionadas con la disciplina. En este trabajo se revisa la primera experiencia académica de la comunidad farmacéutica en su nuevo espacio de instrucción, a partir de los expedientes de los estudiantes inscritos en el Establecimiento de Ciencias Médicas de 1833, año de su fundación, a 1865, cuando se inscribió la última generación. La información de los 163 expedientes ilustra las transformaciones ocurridas en el ámbito farmacéutico luego de la reestructuración de su entorno profesional. El lector notará la diversa normatividad que pretendió regular el ingreso de los farmacéuticos a la vida académica de la que hasta entonces estaban excluidos y verá cómo entre los primeros inscritos al Establecimiento de Ciencias Médicas dicha normatividad fue transgredida para adaptarse a las formas ya conocidas por estudiantes y profesores. Progresivamente, la instrucción de tipo gremial sería desplazada por la institucional, al desdeñarse los años de práctica en las boticas, de manera que las formas gremiales de enseñanza se fueron transformando para hacer del farmacéutico un personaje de instrucción institucional. [ABSTRACT FROM AUTHOR]

In this paper, we analyze Juan de la Fuente's life and work. De la Fuente was a medical doctor with medical studies in Sigüenza and Sevilla, minor Spanish universities at that time. Born in Mallorca, he came to New Spain in 1563 and later, he was the first professor in the new Faculty of Medicine in the Royal and Pontificial University of Mexico. His life could be considered as an example of a brilliant professional career developed by a Spanish Medical Doctor coming to the New World, in his case to Mexico. Being a doctor in the main Mexican hospitals, and caring for numerous and select patients. Also was selected as visitador and protomédico, important responsabilities in the regulation of medical practice and quality of medicaments. As a cultivated man, he was a typical case of a humanist. He not only was interested in medicine, but also in natural history, dialectics and philosophy, with a good knowledge of Latin, classical literature and so on. He won the first Medicine Cathedra in 1578 and continued in this place until his death. [ABSTRACT FROM AUTHOR]

One of the current challenges of bioethics is to look at diversity in health care, and especially avoid hegemonic criteria established as normative and do not include diversity. In some situations, such policies contributed to the exclusion of the difference in what is supposedly enshrined as «normal". This includes the difficulties that are generated against health issues when approached from a cultural perspective, because the diseases are not equal and do not manifest the same way in different cultures, i.e. there are different ways of getting sick, which can be determined culturally. At the same time, bioethics is a proposal about the ethical conflicts related to life in general, so this article aims to explore how to structure the connection between an ethic of life (bioethics) and health from an intercultural perspective. [ABSTRACT FROM AUTHOR]

The aim is to describe the environmental and the practice of the medicine around the 1910, year of the Mexican Revolution. Prominent physicians and theirs contributions are describe. All of them from the Mexican clinical school development by Manuel Carpio and Miguel Jiménez. It is stand out the progress of the Mexican medicine with the incorporation of the European advances into the daily practice. It is also describe the development and contemporary practice of surgery of the Mexican surgery school forced by surgeons like Miguel Muñoz, Francisco Montes de Oca and Rafael Lavista. [ABSTRACT FROM AUTHOR]

Around the end of century XVIII the surgery of Nueva España was integrated to the renovation process that was given in Europe from principles of the illustrated century. As a result, the Royal College of Surgery was created; this institution was responsible for the education of surgeons of the kingdom, introducing and spreading the new and modern medical surgical theories. During the war of independence the College demonstrated its importance when they needed the graduates and students to serve the army. In the independent Mexico, the College of Surgery changed its name to the National School of Surgery and its work was the preparation of surgical personnel. Several of the physicians promoted diverse projects to modernize the health disciplines, which resulted in the creation of the Establishment of Medical Sciences in 1833 bringing about the integration of the medical career. [ABSTRACT FROM AUTHOR]

Resumen La decisión de los padres de no aplicar vacunas que son “obligatorias” a sus hijos genera dilemas en los médicos y pediatras. ¿Qué debe hacerse cuando los padres no consienten la aplicación de vacunas a sus niños? ¿Esto sitúa a los niños en riesgo suficientemente grave como para que amerite la notificación a los servicios de protección infantil del Estado y que se trate como negligencia de parte de los padres? ¿Qué debe hacerse cuando, por no inmunizar a sus hijos, se pone en riesgo a terceros? El principio del interés superior del menor implica velar por el beneficio del niño sobre cualquier otra situación. Al respecto, los padres antivacunas tienen argumentos para justificar su postura. Los médicos no pueden obligar a los padres a vacunar a sus hijos. Sin embargo, bajo el mismo principio, deben velar por el bienestar del niño y permanecer alerta de que los padres no rebasen el umbral de daño al menor. Si los padres ponen en riesgo de daño grave a su hijo al tomar la decisión de no vacunarlo, entonces estará justificada la intervención legal en la decisión. Este recurso debe ser la última opción, pues los conflictos, en su mayoría, deben resolverse en el seno de la relación del médico con los padres. The decisions of parents to forego vaccines “mandatory” for their children generate in physician and pediatricians some dilemmas and issues such as what to do when parents do not authorize administration of vaccines to their children? Do parents place their children at risk severe enough to notify governmental child protection services and treat this as parental negligence? What to do in the situation where the parental decision to forego immunization of their children affects others? The best interests of the child include ensuring the child's benefit over any other situation. Related to this, parents against vaccines have arguments to justify their position that physicians cannot force parents to immunize their children. By the same principle, physicians must ensure the welfare of children and remain alert, respecting that parental decisions do not exceed the threshold of “no harm to the child” and only if the parental decision in regard to foregoing vaccination places the child at risk of serious harm is government intervention justified. This resource should be left as the last resort because most conflicts must be resolved within the relationship of the physicians with the parents. [ABSTRACT FROM AUTHOR]

Resumen La atención médica en pacientes pediátricos está condicionada a la autorización de los padres. Estos deciden el momento y tipo de tratamiento que desean que sus hijos reciban cuando enferman y, bajo su consentimiento, el médico procede a otorgar la terapia más apropiada. Cuando los padres rechazan el tratamiento ofrecido, el médico debe buscar otras alternativas de tratamiento que sean mejor aceptadas por los padres y encontrar el cauce que sea más benéfico para el niño. De no poder conciliar con los padres una terapia, entonces el médico entra en un conflicto ético relacionado con el mejor interés del menor y las decisiones paternas. De lo anterior surgen las siguientes interrogantes: ¿cómo debe actuar el médico cuando enfrenta esta situación?, ¿debe solicitar respaldo jurídico que fuerce a los padres a aceptar el tratamiento?, ¿bajo qué condiciones está justificado obligar a los padres o cuándo debe ser tolerada su decisión? ¿Cuál es papel del Comité de Bioética Hospitalaria en este tema? Esta segunda parte se enfoca en proponer cuatro criterios prácticos para que el médico y el Comité de Bioética Hospitalaria utilicen cuando todas las terapias alternativas y opciones conciliatorias se han agotado con los padres que rehúsan el tratamiento, y cuando el médico tenga que tomar una decisión porque el menor está en riesgo de daño. Dicha decisión gira en torno a si existe peligro evitable para el niño derivado de las decisiones de los padres. Medical care in pediatric patients is conditional to parental consent. Parents decide the time and type of treatment they want their children to receive when they are ill. The physician should request parental consent before carrying out the most appropriate therapy. When parents refuse the treatment offered, the physician should seek alternative therapies that may be better accepted by parents and find the most beneficial treatment for children and their families. If physicians and parents are unable to agree on the best therapeutic methods, then the physician becomes involved in an ethical conflict related to the best interests of the child and parental choices. From the above posture, the following questions arise: What should the physician do when faced with this situation? Should the physician use legal measures to force parents to accept treatment? Under what conditions is it justified to force parents and when should the decision be tolerated? What is the role of the Hospital Bioethics Committee concerning this issue? This second part focuses on proposing four practical criteria to be used by the physician and Hospital Bioethics Committee when all alternative therapies and conciliatory options have been exhausted with parents and they continue to refuse treatment. The physician then has to make a decision because the child is placed at risk of harm. This decision focuses on whether there is danger to the minor arising from the decisions of parents and if such harm is avoidable. [ABSTRACT FROM AUTHOR]

Resumen El consentimiento informado es un derecho de todos los individuos y nadie puede obligar a ninguna persona a recibir un tratamiento en contra de su voluntad. Este derecho de aceptar o rechazar un tratamiento no desaparece en los individuos que son incompetentes desde un punto de vista legal: este se ejerce en su nombre por un tercero. A los niños se les considera incompetentes para la toma de decisiones médicas respecto de su propia salud, y son sus padres o tutores legales quienes en nombre del niño deben tomar estas decisiones. Sin embargo la autoridad de los padres no es absoluta, y existen situaciones en las que sus decisiones no son las mejores; en ocasiones incluso llegan a poner en riesgo el bienestar y hasta la vida de sus hijos, obligando al Estado a intervenir en nombre del mejor interés del menor. Es por ello que es necesario plantearse las siguientes preguntas: ¿es el interés superior del niño lo que nos mueve a intervenir judicialmente cuando un padre se rehúsa a aceptar el tratamiento médico propuesto, o es el daño que se le causa al menor con esta decisión? ¿Qué tipo de decisiones paternas son las que no deben de tolerarse? Después de hacer una revisión del tema concluiremos que si la decisión de los padres respecto a una decisión médica a tomar en relación con la salud de sus hijos se juzga hecha con maleficencia, es decir dañina para el menor, se justifica que el Estado intervenga. En la segunda parte de este artículo exponemos cuatro criterios que pueden ser utilizados en la toma de decisiones de casos complejos, donde los padres rehúsan aceptar el tratamiento para sus hijos. Informed consent is a right of all individuals and no one can force anyone to receive treatment against their wishes. The right to accept or refuse treatment persists in individuals who are incompetent from a legal point of view; this is exercised on their behalf by a third party. Children are considered incompetent to make medical decisions about their own health and their parents or legal guardians are empowered to make those decisions. However, parental authority is not absolute and there are situations where their decisions are not the best, sometimes leading to jeopardizing the well-being and even the lives of their children, forcing the state to intervene on behalf of the best interests of the child. This is the reason why it is necessary to ask the following questions: is it really the child's best interest that moves us to legally intervene when a parent refuses to accept the proposed medical treatment or is the damage done to make this decision? What kind of parental decisions are those that should not be tolerated? After a review of the theme, we conclude that if the decision of the parents regarding a medical decision is considered to be made with maleficence that is harmful to the child, it is justified that the State intervenes. Finally, we exposed four criteria that can be used in making decisions in complex cases where parents refuse treatment for their children. [ABSTRACT FROM AUTHOR]