La bioética aplicada al contexto de la práctica médica asistencial cotidiana

Abstract

Introducción: La bioética puede considerarse como una disciplina amplia cuya rama biomédica abarca los problemas relacionados a la ética de la asistencia y la investigación en los seres humanos. El ejercicio de la profesión médica conlleva en sí mismo la dignificación del hombre y no puede concebirse la actividad sin contemplar la dimensión ética de la vida humana. El enorme avance técnico y científico de la Medicina y el cambio de paradigma en la relación médico paciente han generado transformaciones profundas en el escenario de la práctica asistencial. Objetivos primario: reconocer, mediante una encuesta, la manera en que los profesionales médicos aplican o interpretan aspectos bioéticos esenciales en la práctica asistencial. Objetivos secundarios: Establecer si los años de ejercicio profesional, la capacitación formal en bioética o la especialidad de oncología (por su condición de mayor contacto con enfermos terminales) modifican las respuestas a algunos dominios del cuestionario. Material y métodos: Se diseñó una encuesta a los fines de la investigación, compuesta por 23 dominios o preguntas con respuestas de opciones múltiples. El cuestionario interrogó sucesivamente aspectos bioéticos sobre consentimiento informado, el menor maduro, población vulnerable, veracidad en la relación médico paciente, secreto médico, objeción de conciencia, decisiones al final de la vida, limitación al esfuerzo terapéutico, ley de voluntades anticipadas, el deber de no abandonar al paciente, los costos en salud y los principios éticos en la deliberación moral. Mediante la herramienta informática Google Drive se distribuyó entre médicos de distintas especialidades. Las respuestas se recuperaron de manera anónima para su procesamiento estadístico.

Introduction. Bioethics can be considered as a large discipline with a biomedical branch including matters related with ethics of assistance and investigation in human beings. The medical profession performance implies human dignity and it is impossible to think of this activity without considering ethical dimension of human life. The huge technical advances in Medicine and the change in doctor-patient relationship have deeply transformed the clinical settings. Primary objective. To recognize, with the use of a survey, the way physicians apply or understand bioethical aspects in their clinical practice. Secondary objectives. To establish if there is influence of number of years of clinical practice, formal training in Bioethics or being a specialist in Oncology (close contact with end stage-diseased patients), in the answers to some questions of the survey. Material and methods. A survey with twenty three questions with multiple choice answers was performed. The questionnaire consisted of bioethical aspects on informed consent, mature children, vulnerable population, reliability in doctor-patient relationship, medical secret, conscience objections, end-of-life decisions, limitation of therapeutic efforts anticipated will decisions, the duty of not abandoning patients, health costs and ethical principles in moral considerations. The Google Drive Program was chosen and distributed in an anonymous way to physicians with different specialities. The answers were anonymously recovered for statistical processing. Results. One hundred and forty four surveys were received. The participants answered the questions partially and not a single domain was answered by all the respondents. So, the percentages were obtained for each question considering the total number of answers. The mean age of respondents was 50.41(+- 12.14) years. There were 51 answers of women (35.42) and 93 of men (64.58). Predominant speciality was Respiratory Medicine with 42 (29%) answers. One hundred and ten (76.39%) professionals were in the “more than 16 years” group. The median time of specialists´ practice was 19.03 years. Formal training in Bioethics was present in 31 (22%) physicians and training on related disciplines in 14 (11%). The selected variables showed a wide diversity of results as a consequence of individuality in medical practice. Physicians with more than 16 years of medical practice exhibited a lower tendency to employ algorithms in chronic patients in order to improve the relationship (p=0.012). Formal training in Bioethics modified favorably the correct answer on the definition of assent in mature children and identified more frequently the informed consent as a process. Finally, specialists in Oncology did not show any bias when comparing the answers related with end-of-life decisions and therapeutic efforts. Conclusion. Formal training of physicians in Bioethics is highly desirable. However to have this specific training did not show any differences in opinions, maybe revealing that young people who choose Medicine as a profession, would have different moral profile.