Publicado

2021-01-01

Ethical and clinical challenges when providing medical care during the COVID-19 pandemic in Colombia: A global perspective to contribute to the local context

Problemas ético-clínicos en la atención médica durante la pandemia por COVID-19 en Colombia: una mirada global para un aporte local

Palabras clave:

Pandemics, COVID-19, Ethical Issues, Utilitarianism, Intensive Care Units, Decision Making, Mechanical Ventilation (en)
Pandemia, COVID-19, Ética, Utilitarismo, Unidades de cuidado intensivo, Ventilación mecánica, Toma de decisiones (es)

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Autores/as

  • Jairo Echeverry-Raad Universidad Nacional de Colombia - Sede Bogotá - Facultad de Medicina - Departamento de Pediatría - Bogotá D.C. - Colombia. | Universidad Nacional de Colombia - Sede Bogotá - Facultad de Medicina - Instituto de Investigaciones Clínicas - Bogotá D.C. - Colombia. https://orcid.org/0000-0002-7657-1091
  • José Ricardo Navarro-Vargas Universidad Nacional de Colombia - Sede Bogotá - Facultad de Medicina - Decanatura - Bogotá D.C. - Colombia. https://orcid.org/0000-0003-2548-1325

The COVID-19 pandemic has posed many challenges, particularly for health systems, which may be forced to ration the resources available to treat patients with this disease. With its ethical implications, this decision forces health care institutions to choose, among patients with similar vital needs, who will receive the scarce available life support resources in the emergency room or intensive care units based on prognostic criteria.

This utilitarian approach aims to achieve the greatest benefit for the largest possible number of patients; however, in Colombia, its implementation faces several obstacles, such as the medical ethos, the instruments used to define the prognosis, the prioritization criteria, the legal-constitutional precepts, and the economic nature of the provision of intensive care services in the country.

This article aims to reflect on these aspects and propose a model for patient prioritization based on the creation of multidisciplinary teams that make decisions within a transparent, humane, plural, impartial, equitable, and fair methodological framework.

In the context of the current pandemic, these multidisciplinary teams should be guided by four ethical-clinical principles: (a) treat all persons equally, (b) prioritize patients with the worst condition, (c) maximize the benefits that can be obtained from the scarce resources available and (d) preferably select patients with instrumental value.

If these four principles are followed, the guidelines drawn up by the Colombian Government concerning the care of COVID-19 patients would be fulfilled within a context of ethical medical autonomy and scientific and professional practice determined by a utilitarian perspective.

La pandemia por COVID-19 ha generado muchas dificultades, sobre todo en los sistemas sanitarios, los cuales podrían verse obligados a racionar los recursos disponibles para la atención de pacientes con esta enfermedad. Lo anterior obliga a las instituciones de salud a escoger quién puede acceder a los escasos recursos de soporte vital disponibles en los servicios de urgencias o en las unidades de cuidado intensivo, una decisión de connotación ética que debe tomarse desde una perspectiva utilitarista, entre pacientes con necesidades vitales similares y según los criterios pronósticos de cada individuo.

La aproximación utilitarista busca el mayor beneficio para el mayor número posible de pacientes; sin embargo, en Colombia su implementación enfrenta varios obstáculos, tales como el ethos médico, los instrumentos empleados para definir el pronóstico, los criterios de priorización, los preceptos jurídico-constitucionales y la naturaleza económica de la prestación de servicios de cuidados intensivos.

Dado el panorama, los objetivos de este artículo son reflexionar sobre los aspectos relacionados con la asignación de los recursos de cuidado intensivo a pacientes con COVID-19 ante una posible escasez de los mismos y proponer un modelo de aproximación para dicha asignación basado en la creación de equipos multidisciplinarios que tomen estas decisiones dentro de un marco metodológico transparente, humano, plural, imparcial, equitativo y justo.

En el contexto de la actual pandemia, estos equipos podrían guiarse por cuatro principios ético-clínicos para tomar las decisiones de asignación de los equipos: i) tratar a todas las personas por igual, ii) priorizar a los pacientes cuya condición sea peor, iii) maximizar los beneficios que puedan obtenerse a partir de los escasos recursos disponibles y iv) darle prelación a aquellos pacientes con un valor instrumental. Si se siguen estos cuatro principios, la atención de pacientes con COVID-19 se daría dentro de un marco de autonomía médica ética, además la práctica científica y profesional estaría determinada por una perspectiva utilitaria.

 

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