A moralidade da alocação de recursos no cuidado de idosos no centro de tratamento intensivo

Abstract

The world is ageing. In Brazil and several other countries worldwide, the changes in the population age mix came along with increased demand for expensive health care. Currently, some moral conflicts arise from allocating public resources for health, as the magnitude of social health inequalities and limited resources require the public management priorities to be based on knowledge of the health situation and the impact of policies, programs, projects and actions on health. In this context, the intensive medicine both managers and physicians involved in intensive care, are subject to moral conflicts, especially concerning fair resources micro-allocation for the elderly in the intensive care unit setting. This paper aims to review these conflicts under the bioethics tools light.

Measurement reliability of endotracheal tubes cuff pressure between industrial and handmade devices

“…The financial reality of public health services is very poor with a deficit of basic inputs. As raised by Freitas and Schramm (31) , in Brazil the social and regional disparities mean that the health needs vary, falling to the managers of health policies, the responsibility of rationalizing the resources available (31) , since the high cost of a specific equipment to measure the cuff pressure can be a barrier to its acquisition. Thus, the handmade model could be an inexpensive cost-benefit in minimizing this lack of equipment and control cuff pressures.…”

Narratives of Health Professionals Relating to Scarce Resources in an Urgency Service

“…A microalocação de recursos está relacionada à discussão e análise das formas de seleção individualizada de pessoas que serão beneficiadas pelos serviços disponíveis, uma vez que estes são escassos. Para tan to, podemos citar como exemplos de recursos escassos: estrutura hospitalar insuficiente; falta de leitos; número insuficiente de profissionais; restrição de acesso a drogas e insumos de maior eficácia e eficiência e a equipamentos tecnológicos [10][11][12] .…”

Argumentos morais sobre inclusão/exclusão de idosos na atenção à saúde

“…De fato, o processo de tomada de decisão médica, relativa a pacientes idosos, remete à espinhosa questão da microalocação de recursos, considerados escassos quando não finitos. Neste âmbito, a discussão moral pelos profissionais de saúde intensivistas no CTI corre sempre o risco de ficar restrita ao campo técnico, o do saber-fazer médico 41 .…”