Bioética y psicoterapia: ¿Cuáles supuestos morales actúan cuando ejecutamos un acto psicoterapéutico?

Abstract

Background: Since about 1970 biomedical ethics crystallized into a full-fledged discipline. The so called «ethical turn» is a fundamental conceptual challenge for the field of medicine and has generated heated controversy. Today, the ancient psychotherapeutic framework is under the severest strain in its long history. Aim: To review the relationship between psychotherapy and the conceptual shift in moral theory. Material and method: To forge a new model for the patient-physician relationship, speech acts and nature of man derived from a «pragmatic turn» of bioethics. Results: Research findings suggest that behavior, cognitive and psychodinamic psychotherapies are speech-acts constituted by a hierarchy of subordinate acts distributed on three levels: the level of the locutionary act, the act of saying; the level of the illocutionary act (or force), what we do in saying; and the level of the perlocutionary act, what we provoke by the fact that we speak. Conclusions: Advances in linguistic research have led to a more sophisticated understanding of how psychotherapy affect ethical issues. These developments point towards a new era of psychotherapeutical theory and practice in which specific modes of psychotherapy can be designed to target specific dilemmas of medical ethics (Rev Méd Chile 2004; 132: 243-52)