Orientaciones éticas para la toma de decisiones médicas en el contexto de la pandemia de COVID-19 en Chile

Abstract

Ethical guidelines for medical decision-making during COVID-19 pandemic in ChileThe catastrophic emergency experienced by many countries with the CO-VID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.

COVID-19 and Ethics: A Latin American Perspective

“…One of the main clinical issues is fulfilling the demand for medical care when it overcomes the available resources. 2,[5][6][7] For this reason, health care professionals have to ration resources and even limit the provision of care: intensive care unit beds and mechanical ventilators stand out as some of the scarcest resources to allocate. This is particularly true for LatAm countries, which have health care systems chronically underfunded due to lack of resources and politically driven decisions.…”

“…This is particularly true for LatAm countries, which have health care systems chronically underfunded due to lack of resources and politically driven decisions. Despite the publication of several ethical guidelines, [5][6][7] these situations still entail a significant moral burden for professionals, already putting up with an overwhelming workload. 2 Another critical situation is isolation of the critically ill patient.…”

“…In the context of a pandemic, caring should take priority over curing more than ever. 6,10 Following Callahan, "it is the vulnerability that illness creates that most requires the response of others. I call that response one of 'caring.'"…”

“…2,5,7 Appropriate therapeutic proportionality judgments are more necessary than ever to assess who is going to be effectively benefited from intensive care unit treatment. 6 The clinical resources provided to patients must not depend on their socioeconomic status: fair health care access is imperative. Furthermore, one of the main priorities must be the protection of health workers, not only because they are essential for the adequate care of the population 4 but also because protecting them is an expression of respect for their dignity.…”

“…In the context of a pandemic, caring should take priority over curing more than ever. 6,10 Following Callahan, “it is the vulnerability that illness creates that most requires the response of others. I call that response one of ‘caring.’” 10 Despite the scarcity of resources, health care professionals cannot give up on compassionately caring for every patient, according to their needs and available resources.…”