sofia.salas@udp.cl E l 31 de enero de 2015, la Presidenta de Chile envió al parlamento un proyecto de ley que regula la despenalización de la interrupción voluntaria del embarazo en tres causales: cuando la mujer se encuentra en riesgo vital, cuando el embrión o feto padezca una alteración letal, y cuando el embarazo es resultado de una violación 1 . Dicho proyecto reconoce el derecho del médico a negarse a realizar el procedimiento si ha manifestado su condición de objetor de conciencia a las autoridades correspondientes y limita dicha libertad de conciencia "en el caso que la mujer requiera atención médica inmediata e impostergable", circunstancia en la cual no puede "excusarse de realizar la interrupción del embarazo en la medida que no exista otro (a) médico (a) cirujano (a) que pueda realizar la intervención" 1 .Dada la importancia del tema de la objeción de conciencia (OC), el Departamento de Ética del Colegio Médico ha considerado necesario revisar este concepto y su fundamentación ética y legal, especialmente en el ámbito de la salud sexual y

Every so often, in Chile there is a discussion about the role of physicians in the care of people on hunger strike (HS). In this document, we review the ethical aspects of health care for persons in HS, aiming to provide guidelines to medical doctors who are required to attend them. First, we make an important distinction between HS and suicide, since the former is used as a protest and denunciation tool, while suicide seeks deliberately to end a life. Then we describe the three roles that the health professional can fulfill: as a treating doctor, as an expert or as an official of a prison. The respect for the autonomy and dignity of the person in HS must prevail whatever the role of the physician. Therefore, we maintain that under no circumstances, people who have autonomously decided to be in HS should be fed by force. Due to the complexity of the issue, we make special considerations about the management of minors and the non-competent persons in HS. In conclusion, we adhere to the principles that inspire the Declaration of Malta, which indicate that it would be preferable to "allow a person on hunger strike to die in dignity, rather than subjecting them to repeated interventions against their will".

Legalization of medically assisted death: its potential impact on the development of palliative care In Chile, there are four bills to legalize euthanasia, an act which public surveys report as supported by most of the population. At the legislative, healthcare and social level, there is an active debate about euthanasia, the rights of terminally ill patients and the context of Palliative Care (PC) in the country. Chilean literature on euthanasia focuses mainly on the ethical analysis of the act itself but does not address the moral legitimacy of the legalization of this practice. This distinction is relevant since the probity of a particular action does not determine the moral legitimacy of its implementation at a public policy level. One aspect of this dimension is the potential negative impact of the legalization of physician-assisted death (PAD) on the development of PC services. This issue is particularly relevant in Chile, where PC provision is currently suboptimal and mostly restricted to cancer patients. This paper analyses available evidence on the potential impairment of PC development after PAD legalization. Although the analysis of evidence has some limitations, this concern is not supported by the available evidence. However, any project about PAD legalization must contemplate a factual commitment with the development of minimum PC provision, according to international recommendations.

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Ethical arguments for and against the participation of the medical profession in assisted death: analysis of the Ethics Department of the Chilean Medical AssociationThe discussion of a bill that allows medically assisted death (MAD) in Chile, revived the debate about the ethics of this practice. The Department of Ethics of the Chilean Medical Association herein analyzes arguments in favor or against the participation of the medical profession in MAD. Among the main arguments against the participation of physicians in this practice are that MAD conflicts with the basic ethical principles of medical practice, that it is contrary to the purposes of medicine and that it could erode the patients' and society's confidence in physicians. The arguments in favor are related to physician´s compassion and non-abandonment of patients during their illness, choosing palliative care and ushering them to the final instance. Additionally, there is social expectation that this practice will be carried out by trained physicians who can verify that the strict criteria established by the legislation are met, guarantee that it obeys to a repeated request of a fully capable patient, and who is able to deal with the complications of the procedure. In this document we aimed to represent the different perspectives about physicians' participation in MAD, offering arguments to colleagues and stimulating their participation in this important debate.