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Prof. Dr. D. Alfonso Ruiz-Mateos M ª Jiménez de Tejada (*).

With this contribution of Professor. D. Alfonso Maria Ruiz-Mateos on Ethos of Psychiatry ICAPSI the grandstand is enriched in wisdom and knowledge, which is why all of us in the Institute does not have the words to thank you for your generous, generous and selfless cooperation.

Once again we show your great humanity, generosity, kindness and good nature.

On behalf of the Institute, thank you very much and a hug with my friend.

Miguel Pérez-Camacho Duque
ICAPSI Director of

CONTENTS 1. Ethos.

2. Ethos: The primacy of feeling.

3. Basic tenets of the ethos of psychiatry.

- Ethos relevance of psychiatry in the field of medicine.

- Considerations on the ethos of the psychiatrist.

- The formation of the ethos.

"Considering that freedom, justice and peace in the world are based on the recognition of the inherent dignity and of all equal and inalienable rights of all members of the human family."

"Whereas disregard and contempt for human rights have resulted in barbarous acts which have outraged the conscience of humanity (...)"

Let me are these two preambles of the Universal Declaration of Human Rights adopted and proclaimed the December 10th of 1948 by the General Assembly of the United Nations, to spearhead this contribution. Together with them I would also note that the medical profession, if we leave aside the strictly religious, has been the first to ensure its "ethos" with promises, oaths and codes of ethics or conduct. The "Hippocratic Oath" does go into medical awareness since its first formulation in the fourth century BC Today, most medical schools still continue the tradition of commitment or explicit pledge, use the Geneva Declaration approved by the Association World Medical in September 1948. This statement is mainly based on the classic Hippocratic Oath. Just want to highlight two postulates:

- "I shall exercise my profession with conscience and dignity"
- "The health of my patient will be my first concern."

From the "Hippocratic Oath", unions and similar institutions and, in recent decades, the WHO ., Have tried to capture the ethos doctor and adapt to the different requirements of the process of civilization by formulations Codes , declarations, letters, etc ... (See pages of notes an overview of the main contributions in this regard from the year 1947) (1)

1. Ethos.

In the Hellenic world the word "ethos" conjures up different meanings. The most primitive means "dwelling", "residence", "place where one lives." In this respect has been highlighted by the current particularly existentialist M. Heidegger: "dwelling place of being," "human style of dwelling and dwelling." The acceptance, however, more common and has been imposed, especially after the influence of thought artistotélico, refers to "character" or "way of being" (2) even more, "he pointed out the semantics of the" ethos ", it should be noted that when he was writing" Epsilon "(" e "soon) referred to the concept of" usual "whereas if it was written with" eta "(" e "long) are designated" confidential. " These two contents would later be joined in the Latino culture in one word: "we", but with the serious danger to the ethic that has greater resonance meaning "custom" than "character." (3) St. Thomas and went the passage of this danger:

"Mos can mean two things: sometimes has the usual meaning, other means a natural or near natural inclination to do something, in this sense it is said that the animals are accustomed. For this double meaning in Latin is a word, but in Greek has two words "(4)

The contemporary writers in the ethical and moral issue, giving more importance in the nuclear configuration of this science to the" ethos "character" that the "ethos" custom. "

But at this point we want to clarify the meaning of character. It is interesting to see how the philosophers of ethics rely on this subject to the contributions of medicine, particularly psychiatry and psychology, as was presumably have found ambiguity and ambiguous reality with which the word "character" goes through these sciences. Recall, by way of example, the attempt to Kretschemer to differentiate the different temperaments under the generic title: "Constitution and Character."

The desire to define the terms "temperament" and "character" appears in most writers. The tension seemed sedated with simplistic to relegate to a word like so many semantic resonances the "temperament" plots that seemed lowest in the mind, that is, apparently linked to the somatic substrate: the sensitive, instinctive and emotional. Leaving located under the term "character" (from "thickets", "jaracter" burn, carve, mark) the phenomena considered above: the volition and intellect. The character would, therefore, to mean behavior, behavior in the person's usual responses, according to the dictates of the will and intellect. With these constraints the "ethos" could have found its proper place within the complexity leaving human stereotyped in the world of volition and intellect, that simple. But, of course, these abstractions are faced again with the ends of an infinitely more sophisticated knot which tied the yoke to the chariot of the king launches Phrygians, the Gordian immortalized. The phenomenon of the human person is presented, first as a singular originality and unity, but on the other, or better, and for all, as unfathomable mystery, a microcosm of the macrocosm, or, if preferred, the reverse.

As the subject of psychiatry has "the whole man." But who would not shudder that goal, which evokes apprehension vaunted courage and presumptuous as impossible.

is logical that we have made use of all techniques at our disposal for dissection. After the continuous search for clarifying stratifications - (remember the most recent the Rothacker, Kleist and Braun, Hartmann, Hoffmann, Ortega , etc ...)- conclude once again that it is useless: the human being beyond all attempts to subdivisions. Herein lies the greatness and the risk "tragic" in the sense-of Psychiatry krestschemeriano. The recurring waves of tests to capture and systematize the infinite resonance of the person hitting the seawall will nebulous mystery-what. Eventually paraphrasing end one way or another Janet synthesis :

"Il n'est pas juste dire que l'homme of thought are cerveau avec, ce n'est pas avec are cerveau c'est qu'il pense avec are corps tout entier. Il pense avec ses doigts, il pense avec ses pieds, avec are ventre avec comme il pense are cerveau, il pense avec l'ensemble "(5)

Synthesis, indeed, very poor because you miss nothing less than the dimension history of the human journey, past and future draft of this ambiguous anchor.

Where is, therefore, located the "ethos"? M. Vidal highlights the contributions in this regard Aranguren of JLL relating the "ethos" (moral) with the "pathos" (spirit).

"The ethical and the pathic have an affinity that deserves special attention. The same could be said for the aesthetic, according to the formulas 'nulla aestethica ethica sine' and 'sine nulla ethica aestethica'. " (6)

The author considers that it has been Aranguren who has studied more originality with the notion of "spirit" and its relationship to the "personality" (7)

"The" pathos "or spirit is our way of find good, bad, sad, confident, fearful, desperate, etc, in reality. The "pathos" is not dependent on us, on the contrary, we who are with him and in him. That's exactly why Heidegger was able to speak the "Geworfenheit." We have been set in the world "dumped" on him, or rather sent to him with a hope or anxiety radical, permanent fund that leaves little to the surface of the changing moods, feelings and passions "(8) Before

this last statement: "leaves little to the surface, I think that practitioners of psychiatry Aranguren would invite some contacts, but other than passengers, to clinical reality. The author continues:

"Facing the main irrationalism of Heidegger the mood is not the first existential, not our first opening to the reality or world, it naturally assumes the" intelligence "understood as being in reality and as the constitution of that world after the "pathos" is going to color emotionally cold or burning range, with a dark palette or burning "(9)
pathos and ethos, spirit and character, are thus correlative concepts. If "pathos" or spirit is by nature how to deal with reality, "ethos" or character is the way the habit of dealing with that same reality ... Mood and character are therefore two opposite poles of the ethical life; premoral one, the other truly moral. But it matters much to note that are separable only by abstraction ... The man is a radical unity that involves feelings of intelligence itself, nature and morality, spirit and character "(10)

2. Ethos: The primacy of feeling.

The concept of "spirit" in Aranguren, hegemony, he gives as the first existential intelligence and the fact of reducing the complex phenomenon of the "ethos" to how to deal with the habit "reality" requires, in my opinion, great qualifications.

Clearly, as we have noted, that any attempt to dissect the vital unity of human beings is only possible through the power of abstraction of the intellect.

Abstraction is always the basic tool of all sciences, including anthropology. We can not do without it. But we must remain always on alert, especially in psychological and psychiatric sciences-not to make a real finding, but plot in ontic and absolute. Here lies, in my opinion, one of the most dismal failures, the one that has produced tensions within the "ethos" of psychiatry. (11)

bipolar tension between pathos and ethos, spirit and character, and the status of "pre-moral" for the first come to influence the Socratic conception of the man who has exerted so much influence on Western civilization . Remember how St. Paul picked up the knowledge of his time about giving a Christian orientation:

"For the flesh has desires against the spirit and the spirit against the flesh, as being antagonistic to each other, so do not do what you would. But if you are led by the Spirit, ye are not under the law "(12)

The dichotomy between "lust" and "why" question in our conception of man. Attempts to new approaches have only achieved most of the time, falling into the playful world of semantic changes.

remember the "Lustprincip" or the pleasure principle and the "Realitatsprincip" or the reality principle of Freudian phenomenology.

Particularly eloquent in this respect is the reference to "estimate of instincts and instinctive change" of E. Kretschemer :

"Man is the tragic animal. While his instincts have not been modified and not nearly remain in an archaic level, their intellectual development is completed so quickly that all the works of reason becomes an instrument of destruction. The animal man is tragic. Today, although part so as primitive and extol So instinctive is not enough to govern with confidence, not reason enough to take over the instincts. Are we so chanting slogans and disparaging fashion right? Never again!. The reason has more downside than most men do not have it in far enough "(13)

I think we need a different orientation to illuminate the substrate deepest ethos. Tension "pathos" - "ethos" sins of the simplistic dichotomy referred to above, because the dialectical drama hangs the so-called "lower psyche" (feeling, instinct, inclination) against the "superior psyche" (intellect, volition) but any of the layers of the human person. We could look instincts versus instinct affectivity versus affective, etc ... I agree with the statement López Ibor :

"The truth is not in the dilemma but in the copulative (...) layer theory is just that: a theory used to better interpret and describe the facts , and only the heuristic value is taken in these pages. These differences in description and drawings of separation of the layers show its relativity: if human beings were formed, really, for three overlapping blocks, there would be doubts about the topography of the fissures separating blocks "(14)

In Indeed, the authors mentioned above also support this line of thought. But the issue of the overlapping of "ethos", but to surface the person as unitary reality, does not consider that his first existential intelligence, but deep feelings. The "ethos" has experienced, especially in the West, a course similar to the word culture. The old Socratic thesis that human behavior is the sequel expressive world of ideas has been highlighted in a primary-say, overwhelming, in our civilizations. If we take a dictionary of the languages \u200b\u200bof our countries we see that the word "culture" is referred to in preference to the noesis or ideological enrichment. Our lability of equating culture with bookish and information is evident. How often in contact with people "illiterate" but in balance with "nature-natural" as we say today, I found its existential meaning and behavior to the big questions of human metaphysics to the point of questioning: Who are the educated or cultivated; them illiterate or I appointed my bookish background?

psychiatric anthropology long ago discovered that the real driving force of the person, both individual and collective dynamics, is affected. "What is the actual emotional" is an aphorism that I like to bring up whenever I can. Recall Augustine's outburst: "Amor meus pondus meum!"

"Every body weight tends to place his own. The weight tends not just down, but into place. Tends the fire up, down the stone. Your weight carries, at its own site van. Spilled oil on the water rises above the water, and water spilled over the oil under the oil húndese; carries weight, go to your own site. What is restless messy, once ordered to rest. My weight is love, takes me wherever I am born "(15)

apparently only the noetic, the concrete world of ideas is what triggers the inventions, great and small revolutions. But I think being consistent in saying that the real managers and Birth "of ideas are deep feelings. Moreover, the feeling is one that allows the opening and reception of the receiver, which achieves the vital counterpoint which is the encounter of all aesthetic pleasure. The ideas we slide if they fail to stimulate the resonances of our emotional life. We are faced with complex circles of interactions and reciprocal influences arising from the unity of the person charged with a wide range of springs and resonances. But if we raise the issue in the field of priorities, in the sense of the primacy hierarchy when punching the psychic world of the person, and even in a chronological order, our position is tilted strongly for the priority of feelings . The old scholastic argument that human beings are born "tamquam tabula rasa" has been sufficiently overcome by the present knowledge about the "genetic memory." The term "memory" also runs the danger of being referred primarily to the world of the ideal. Not so. Physiologically, the formation of engrams affects primarily in the complex world of feelings. Mean by "engrafía" according to Semon:

"the process by which the stimuli cease definitive and permanent traces in the protoplasm of the cells" (16)

features therefore can be hereditary. Have enjoyed much CG Jung with current contributions of science to have a physiological substrate to justify the possibility of "collective unconscious" and "archetypes" realities that otherwise arouse the sentiments: the irrationality in the depths of the human. (17)

rational psychology found that habits are the result of repeated acts. That statement is a part of the truth and, without doubt, the most insignificant. Is valid when it comes to the plot of the nervous system mainly responsible for learning, improving coordination and voluntary exercise. The virtuosity of the pianist would be impossible without a prior persistent repetition. But the formation of engrams at the core of the brain substrate of feelings, do not follow the assumption of repeated acts as prerequisite. A single stimulus celebrated with great emotional intensity can be much more efficient to leave an indelible mark that repeating the same without emotional resonance. Still in the learning and development of voluntary exercise is necessary to emphasize the importance of attention and interest, phenomena linked to full affect. In short, when I say that "the affective is the actual" no attempt to marginalize any other aspect of personal events, but stress the primacy that have deep feelings in a holistic perspective of human dynamics. If so, is the deep feelings that we must consider the roots more originating in the formation of the "ethos." From these observations admit Ortega makes differentiation between "ethos", "ethical science" and "morality."

"I understand" ethos "is simply the system of moral reactions that act in the spontaneity of each individual, class, people, period. The "ethos" is not the ethics or morality we have. Ethics are the ideological justification of a moral and, ultimately, a science. Morality is the ideal set of rules that may accept with the mind, but often do not deliver. More or less the moral is always a utopia. The "ethos", however, would be like the real moral, effective and in fact spontaneous reports every life. " (18)

The need to initial feelings of awareness when the "ethos" of psychiatry seems more urgent since most have had the same risk of being marginalized by certain currents of contemporary psychology. Contain much of the recent real lines:

"If something quickly and effectively characterized the psychological reality of man in his natural size, are the feelings. However, scientific psychology soon dispensed of this important human dimension. Behaviorism, first, due to its attempt to rely exclusively on the stimulus-behavior and cognitive psychology later, due to its complex system of computer interpretation of human behavior, feelings left the field of philosophy "(19)

Before concluding this section fall into what I once called passion and define default yes, throwing a definition of the term "ethos": the set of autonomous and conditioned deep feelings that emerge from the privacy of the person in relation the world of values, their hierarchy and commitment to them.

points out:

"Deep" in the sense that the semantic mysticism has given the word "Hondón" and, in some way, the "endo", "Endon", "endogeneity" of psychiatric nosology, as these words refer to "roots": "set of backgrounds, interests, habits, or effects that are firm and stable one thing or prevent its replacement or amendment." In contrast, for both sentimental feelings fleeting or superficial as mere rules noetic native socio-cultural inclinations.

"autonomous" to we want to emphasize that feelings are intrinsic to the human condition, feelings associated with their own selfhood, unconditioned or ininfluenciables in its essential core that are very irritated by exogenous stimuli.

"The archetypes have had engendered in the human being and not merely as a residue of past experiences. This is something that corresponds to the essential properties of being. If there is the myth of the hero is because there is a tendency in man power and the irrational parent domain. In my view, we must not forget the needs or responsibilities of the human being or, what is, 'the irrational in man' "(20)

"Securities" within the meaning of "scope of the meaning and importance of any reality" as seen from the degree of relevance and maturant harmonious integration of individuals and groups.

3. Basic tenets of the ethos of psychiatry.

- Ethos relevance of psychiatry in the field of medicine

To B. Häring ethos:

"includes those attitudes that characterize distinctive culture or as a professional group or profession that this culture holds a position that demonstrates the commitment to certain values \u200b\u200band hierarchy of values" (21)

What we want to emphasize is the relationship that the author makes between "ethos" and profession:

"A truly significant use of the term" ethos "includes membership of a profession, understood as a vocation in the sense of irrevocable to the community service and dedication to values \u200b\u200brather than financial gain (...) The "ethos" arises within the profession and more specifically formulated for those who represent a common way, for those who through history have been as models for the profession "(22)

is clear that my concept of" ethos "no coincides with that of Häring, but I think that his reference to the professional it can be useful to delve and specifically in the field of psychiatry. Alonso Fernández

begins his book "Fundamentals of Current Psychiatry," with these words:

"The qualitative and quantitative importance of psychiatry indicates that we have a discipline that is not simply a more medical specialty. Its most distinctive qualitative distinction is to be humanistic or anthropological branch of medicine par excellence "(23)

using scholastic terminology I like to say that psychiatry and his inseparable companion medical psychology, are the substantial form of all medical procedures. The object of medicine is the patient, or the presumed patient, if we consider the preventive dimension, but the object of the medical act constitutes the dual phenomenon and interacted personal encounter.

"Meeting is more than the mere juxtaposition of things and living beings, where the interactions come conditioned by the corresponding forms of relationship. Such a way of being together is done continuously in the lives of men since the crash and fall to their very complicated processes of social mechanism.
But I find something very different. Meeting means that the man was taken to a thing or a living and above all to another man, considers its form, sees its core value, is wounded by his power ... So I can I find the sea or a tree: a man who until now was unknown to me or who had been to many times. I am struck by lightning of his being, I am touched by their action. The relationship was consummated when the other man also "found" and I just. Then there is the found and determined to be mutual.
The man then is made not only for the interaction with other beings, but for the meeting and confirmation is made. There is reference to the other and the other, and while "referred to to "be done is built up and he gets to eat (...) While" you "whole community enters, walks to the real" me. " The most intense experience of personal freedom is love. It is paradoxical that while the subject is the center itself and only itself is still not properly part of himself. But when it comes out of himself and takes over the other to himself, receive from his hand his true self. (24)

If the core of the medical task is the "interpersonal encounter" and Psychiatry and Medical Psychology is the science charge research and teaching of this reality, without a doubt the most sublime and transcendent sound not to boast that consider the "substantial form" of a "material object" in this case would be the whole of medicine. When you do not like the scholastic terminology of coprincipios metaphysical sense I can accept it in analog or if you prefer, metaphorical.

In this pillar, "interpersonal encounter" is supported by the "ethos" of psychiatry with characters that go beyond any possibility of synthesis.

- Considerations on the ethos of the psychiatrist.

The person-to-person and plunges us phenomenon in the incomprehensible and the realities mysteric intramundane.

Before the "you" only be an ideal position, which stems from the reception open to the elusive respect, commitment and integration. These qualities should be heightened, exalted, when the "you"-the specific-psychiatry is sick, but vaguely suggestive dominated, mentally. Its status as such person, unrepeatable uniqueness and personality altered, requires, further, to an open attitude to any sign clarifier with explicit awareness in the aphorism: "In homine nunquam satis."

"What dialogue is essentially personal. Is "you" oriented toward a "you" with whom contact is through the word. On the other hand is something essentially ineffable as it is rooted in the mysterious world of interiority. Any person implies a being and a being that is, to some extent, common to others. In this sense the person is communicable. But also includes something that is simple yet one time. In this other sense the person is incommunicable because language can not convey, but common values. The person is incommunicable both the level of being and in knowledge. Can not be fully understood. Certainly a person can be treated as a thing in nature, but it is a sad fate, which in our world, get to do the "you" thing. " (Buber ). Since in this case the person ceases to be itself a person. A person can never be in the hands of others, but just opposite. Everyone is necessarily closed in on itself. Can not be forced from outside (...) The personal is therefore still view things naturally, a terrifying mystery that can not be known and analyzed intellectually, but only lived with mutual love and treatment "(25)
From these reflections
denounce one of the violations, in my opinion, most unfortunate of the "ethos" psychiatrist. Trying to convert what is merely plot in ontic and absolute dogmatism affecting even paradoxical. And welcome to the libido, overcome, the ancestral, etc ... all contributions from a dimension somatogenic, psychogenic or sociogenic, etc ... But please, be unable to maintain the scientific spirit that comes from true humility that man is overwhelming and that any attempt to close it down into small tight connotes typical bravado of ignorance or, worse yet, of evil? (26) The eclectic positions can be considered as products of faint-hearted or half-hearted spirits. But the eclectic, understood as an attitude radically open to any suggestions that might help to clarify the true mystery of the human being is not the position of cowards but born of an "ethos" conscious and coherent.

Alongside this phenomenon should also release the report of the tremendous tensions that exist among many professionals in psychiatry originating from motives which I sincerely miss. I understand that the psychiatrist, like any professional experience in overcoming embarrassment justified towards chairs or other leadership positions. This is cause for some behavior disorders, given the structure of the society we live in, it happens in all fields thereof. But I want to point to not know what kind of demons are all aware that there are "giving a very negative image of our profession, especially when we dare to throw it, justifiably, as the quintessential branch of humanism and medical anthropology.

Sometimes I have the impression that we have become to psychiatry in a sort of twit whose Pandorga or Claymore or lashes need to be a bit too clever or committed to escape. Anyone who has come to this area by vocation, not easy to stand up to the value of it, and willing to fight a common front in which every effort will always be insufficient, the danger of discouragement with the sad reality of disunity of the most obligations are mutual or integration.

Another serious threat to the ethos of the psychiatrist latitudes comes from foreign to our discipline. Notice how the current controversy of psychiatry has exceeded its own hurdles and becomes the target of sociological theories, economic, political, etc ... In them we show that psychiatry is the branch humanistic par excellence, as such, the more weightless and, therefore, the more helpless for any upstart. Little chance to penetrate and attack are presented to political ideologues, for example, handle specialties such as ophthalmology and otolaryngology from his own scientific work.

But, gentlemen, good will speak out on behalf of all who want to do psychiatry, psychiatry, anthropology open to all, cry out that enough of rude intrusions, which are too long ears not to assume the wolf that sustains them.

cudgels on behalf of the "ethos" of the thousands of professionals who each day are torn between anguish, anxiety, delusions, irreversible damage ... seem unnecessary. But observing that lurks easy wit and irony to sarcasm referring to our patients and, of course, the psychiatrist, we seemed to poor box Velázquez thousand spears. I remember when a venerable teacher found out that I had done my psychiatrist after raids theological and anthropological, whatever occurred to him say was: "Please, a psychiatrist is not nothing but a mad doctor or a doctor crazy." While the joke laughed paraphrased the Pauline phrase:

"For myself would be" crazy "(anathema) from Christ for my brethren, my kinsmen according to the flesh ..." (27)

For all they know of anguish in the flesh, mostly comments. To the stranger who ignore it, we waited until the anguish he was struck in an unexpected turn a corner unexpectedly.

- The formation of the ethos.

Psychiatry long ago discovered that the only skeleton key able to open the privacy of individuals, to the point of being able to achieve therapeutic conversion was not the clarification or noetic imposition of rationalizations, but the emotional empathy, appropriate management transference and countertransference, the empowerment of all crack integrator "Hondón." Not to undervalue the information - would be absurd! - But again exclusive on the polarization it entails an impoverishment of the "ethos" of the consequences seems to resent greatly the current practice of psychiatry.

numerous voices are rising aim to raise awareness that we are witnessing a profound and rapid deterioration of medical ethics and specifically psychiatry especially in the core: doctor-patient relationship.

Perhaps the "ethos" and psychiatric humanism may apply to the same criticism that M. Heidegger was the knowledge of man.

No era has been much discussion of humanism as ours, none has had so many media to propagate their ideas and convictions as ours and no desire pessimistic, perhaps none is attending a higher degradation. Clearly that is not falter even information that lately, in most of our faculties, the Ethics as a subject has ceased to exist.

I think the "ethos" is fermented and stimulates the need for original and innate in man's inner and learn and shapes what you have to acquire, primarily through contact with authentic teachers. This line of thought is the venerable colleagues who have supported and led them to resist the ethics as a subject of the race. For them the only effective teacher ethos and ethics was the climate that all medical students had to breathe in every corner of their respective faculties.

personally think that both aspects are necessary for the formation of the "ethos", but also give primacy to the latter.

finish this work dedicating my admiration and reverence to all colleagues, true masters of psychiatry, who, faithful to its commitment to the ethos in store us the opportunity to be focused and not get lost in the fog.


1. - International Code Nuremberg, on human experimentation, in response to abuses during the war were made in experiments on human beings.
2 .- Geneva Declaration (ratified in Sydney in 1,968). 3 .- Code
London (III General Assembly of the World Medical Association).
4 .- Declaration of the Principles on Medical Certificates.
5 .- Rules of Ethics for wartime.
6 .- Declaration of Helsinki (revised in Tokyo in 1975 by the XXIX General Assembly of the WMA)
7 .- Ethical Principles of Social Medicine (ratified in Madrid for the XXI General Assembly in 1967)
8 .- Medical Letter Social Nuremberg.
9 .- Letter of Doctors Hospital of the Standing Committee of Doctors of the European Economic Community.
10 .- Charter of Salaried Doctors (Brussels).
11 .- Letter of Medical Work (Brussels).
12 .- Oslo Declaration (on therapeutic abortion).
13 .- Tokyo Declaration (on torture).
14 .- Declaration of Hawaii (on psychological treatments). Simultaneously

are changing the various national codes.

In Spain, approving the Code of Ethics developed and sponsored by the General Council of Official Colleges of Physicians and sanctioned in April 1979 by the Ministry of Health and Social Security.

As background to these attempts at codification, we have in Spain Medical Ethics Rules established in a circular of the Supreme Board of Health in 1964. This circular sets out the social role of the physician, regarding it as "health officer" officially required to report situations that involve damage to health.

hospital patient's constitution

"recently approved by the Council of Europe, a document which broadly reflects the fundamental rights of the sick and hospitalized. Among other points they specify the right to religious freedom philosophy, the right to claim and be informed about the state of health, the right to accept or refuse medical intervention and the possibility of seeking advance information on possible risks, respect for privacy, the dignity of the individual in a word, the right to be cared for properly.

The preparation of the letter has taken several years of discussions and studies and a large number of expert meetings. The principles that inspire it emerged from the universal declaration of human rights, the European Social Charter, the international convention of the United Nations on economic, social and cultural rights and the resolutions of the Organization World Health Organization, WHO, adopted in this regard. Its real implementation at national level requires a domestic regulation. Hospitals, in turn, must acquire the means to implement them. "

15. Aranguren, JLL: "Ethics." Madrid, 1972 (21-25)

16. Vidal, M.: "Moral Attitudes" Volume I. Madrid, 1981 (19-20)

17. St. Thomas, "Summa Theologica I-II, 9.58 to 1

18. Confer: Lopez-Ibor, JJ, "Lessons of Medical Psychology." Madrid, 1968 (Volume I -23)

19. Vidal, M.: 1c (23-24)

20. Ibd. 24

21. Aranguren, JLL: 346
22. Ibd.

346 23. Ibd. 348-349

24. I have discussed the issue at greater length: "Medical Ethics and New Constraints of Culture." Proceedings of the Second Conference: Ethics, Law and Medicine. Medical College of Madrid. 21 to 25 May 1979.

25. San Pablo ad Galatas: V ,17-18; ad Romans VII, 19.

26. Confer: Witbrecht, HJ: "Manual of Psychiatry." Madrid, 1970 (627)

27. Lopez-Ibor, JJ: 1.c 23-24.

28. St. Augustine: "Confessions" XIII, 10 (Vega) 442-3

29. Dorland: "Dictionary Medical Sciences. " Buenos Aires, 1,965 "engram", "engrafía."

30. Confer the importance given to the "irrationality" against the "technological rationality of our historical moment."
Ballbe, R. "The psychiatrist and contemporary man." Actas Luso-English Neurology and Psychiatry, 1981 9.2 (89-102)

31. Ortega y Gasset, J.: "Different Destinations." Works. Madrid, 1954 (506-507)

32. Cruz Hernández, M.: "The problem of feelings." Journal Ya 12 February 1982. This is a criticism of the work C. Recent Gurméndez: "Theory of feelings." Madrid, 1981

33. Lopez-Ibor, JJ: "Living" is just dreaming? Daily "ABC" in Madrid January 13, 1982

34. Häring, B.: "Moral and Medicine." Madrid, 1972 (31)

35. Ibd. 32

36. Alonso Fernandez, F., "Fundamentals of Current Psychiatry. Madrid, 1976 1

37. Romano Guardini: "Freedom, grace, and Fate" (S. Schost, 1954) 38.39

38. Schurr, V.: "preaching Christianity in the twentieth century." Madrid, 1956 (112)

39. Ruiz-Mateos, AM: "Medicine, Psychiatry and Morality." Whit # 50 from July to September. Madrid, 1977 (217) (In this work I have tried more complete discussion).

40. San Pablo. Rom. 9.3

* Professor of Psychiatry, Neurology Alfonsiana-Rome University, Doctor of Theology, Sociology and Medicine, President of the Royal Academy of Medical Writers and Member of Scientific Committee of the Canarian Institute of Psychiatry.


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