<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0185-3325</journal-id>
<journal-title><![CDATA[Salud mental]]></journal-title>
<abbrev-journal-title><![CDATA[Salud Ment]]></abbrev-journal-title>
<issn>0185-3325</issn>
<publisher>
<publisher-name><![CDATA[Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0185-33252023000500261</article-id>
<article-id pub-id-type="doi">10.17711/sm.0185-3325.2023.033</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Bioethics and advance directives in psychiatric in the hospital context]]></article-title>
<article-title xml:lang="es"><![CDATA[Bioética y directrices anticipadas en psiquiatría en el contexto hospitalario]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mondragón-Barrios]]></surname>
<given-names><![CDATA[Liliana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lolas Stepke]]></surname>
<given-names><![CDATA[Fernando]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz Departamento de Investigaciones Epidemiológicas y Psicosociales ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Chile Centro Interdisciplinario de Estudios en Bioética ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Chile</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad Central de Chile Facultad de Ciencias de la Salud Instituto de Investigación]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Chile</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>10</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>10</month>
<year>2023</year>
</pub-date>
<volume>46</volume>
<numero>5</numero>
<fpage>261</fpage>
<lpage>267</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0185-33252023000500261&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0185-33252023000500261&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0185-33252023000500261&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction Mental health services have been a focus of human rights advocates and recent legal reforms in some Latin American countries, which have called for a change from the paradigm of hospitalization to one of accompanying and supporting the person with mental health issues, which make it possible to apply the Advance Directives in Psychiatry (PADs). This change will require time, as well as economic, material, and human resources, and transformations in attitudes, culture, and society, but the implementation of PADs cannot be postponed: they must be used to protect the autonomy of the persons affected, within a bioethical framework.  Objective Identify possible bioethical conditions in the prevailing conventional hospital context in Latin America that allow for an implementation of PADs.  Method A participant-observer study was carried out in two psychiatric hospital services from June to September 2022.  Results A thematic analysis found three themes: 1) clinical care, 2) patient predisposition, and 3) medical-legal questions. This study considered part of theme 2, including the following sub-themes: a) patient self-perception, b) biography/narrative versus diagnostic classification, and c) negotiation.  Discussion and conclusion Prominent among the sub-themes discussed are recognition of the values of autonomy and its elements in all of the expressions of the person with mental illness, as well as actions of the physician or health care team in synergy with supported decision-making, a distinctive feature of the anticipatory process of the PAD.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción La atención de la salud mental se ha visto emplazada por los Derechos Humanos y las recientes reformas legales en algunos países latinos, que instan a cambiar el paradigma asistencial de la hospitalización al del acompañamiento y apoyo en la toma de decisiones de la persona en condición mental, que posibilitan la aplicación de las Directrices Anticipadas en Psiquiatría (DAP). Este cambio implica tiempo, recursos económicos, materiales y humanos, transformaciones actitudinales, culturales y sociales. No obstante, la implementación de las DAP no puede postergarse, deben aplicarse basadas en el respeto a las personas en un marco bioético.  Objetivo Identificar las condiciones bioéticas posibles en el contexto hospitalario convencional, imperante en los países de América Latina, que permitan la implementación de las DAP.  Método Se llevó a cabo una observación participante en dos servicios de hospitalización psiquiátrica, entre junio y septiembre de 2022.  Resultados A través de un análisis temático se obtuvieron tres temas: 1) atención clínica, 2) predisposición de los pacientes y 3) asuntos médicos-legales. Este estudio consideró sólo una parte del tema 2 con sus subtemas: a) Autopercepción de los pacientes, b) biografía/narrativa versus clasificación y c) negociación.  Discusión y conclusión En los subtemas discutidos se resalta el reconocimiento a los valores de la autonomía y sus elementos presentes en todas las manifestaciones de la persona con enfermedad mental, se reconoce también el actuar del médico o equipo de salud en sinergia con la toma de decisiones apoyada, que distingue el proceso anticipatorio de las DAP.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Bioethics]]></kwd>
<kwd lng="en"><![CDATA[advance directives]]></kwd>
<kwd lng="en"><![CDATA[psychiatry]]></kwd>
<kwd lng="en"><![CDATA[hospitalization]]></kwd>
<kwd lng="en"><![CDATA[mental health]]></kwd>
<kwd lng="en"><![CDATA[autonomy]]></kwd>
<kwd lng="es"><![CDATA[Bioética]]></kwd>
<kwd lng="es"><![CDATA[directrices anticipadas]]></kwd>
<kwd lng="es"><![CDATA[psiquiatría]]></kwd>
<kwd lng="es"><![CDATA[hospitalización]]></kwd>
<kwd lng="es"><![CDATA[salud mental]]></kwd>
<kwd lng="es"><![CDATA[autonomía]]></kwd>
</kwd-group>
</article-meta>
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