Perspectiva de los dilemas éticos relacionados con la pandemia COVID-19.

Ethical dilemmas related to the COVID-19 pandemic. A perspective.

  • Gilberto Vizcaíno Universidad Técnica de Manabí
  • José Esparza University of Maryland
Palabras clave: COVID-19, ética, dilemas, poblaciones vulnerables, trabajadores de la salud, vacunas

Resumen

Enfrentar la pandemia del SARS-CoV-2, conocida mundialmen-te como COVID-19, constituye un desafío enorme, el cual hay que abordar por los múltiples aspectos de esta enfermedad. Sorprende la rapidez con la que el virus SARS-CoV-2 se ha expandido globalmente, es la pandemia que hoy ocupa toda la atención mundial, no solo por los aspectos médico-epidemiológicos sino también por sus consecuencias en la geopolítica, la economía y la sociedad en general. Desde que se inició la pandemia, la información científica ha ido in-crementándose diariamente en forma notable, se trabaja y se publica sobre su epidemiología, modo de transmisión, manifestaciones clínicas, diagnóstico de laboratorio, tratamientos médicos alopáticos y ya están en fase 3 algunas va-cunas como medida de prevención de esta enfermedad. No obstante, toda pan-demia y en especial esta que nos ocupa, inevitablemente trae adicionalmente una serie de dilemas éticos, tanto en las decisiones de Salud Pública, en grupos poblacionales vulnerables, en el desarrollo de protocolos de investigaciones y en la atención de los pacientes afectados por la infección. La resolución de los conflictos éticos que han surgido en la pandemia COVID-19, debe tener como referencia las pautas bioéticas publicadas por organizaciones internacionales (OMS/OPS) y centros y comités nacionales o institucionales dedicados al cam-po de la Bioética. Esto permitiría una acción responsable frente a la pandemia, sin dañar los derechos humanos y el bienestar individual y social.

Citas

Vizcaíno G, Esparza J. Coronavirus pandemic. Ethical conflicts in COVID-19 times. J Infect Dev Ctries 2020; 14(9):968-970. doi:10.3855/jidc.13137.

Lloyd-Sherlock P, Ebrahim S, Geffen L, McKee M. Bearing the brunt of covid-19: older people in low and middle income countries. BMJ 2020, m1052. doi:10.1136/bmj. m1052.

Esparza J. Lessons from history: What can we learn from 300 years of pandemic flu that can inform the response to COVID-19? Am J Public Health 2020;110(8): 1160-1161. http://doi:10.2105/AJPH.2020.305761.

Lei R, Qiu R. Report from China: Ethical questions on the response to the coronavirus. The Hastings center.org. https://www. thehastingscenter.org/. Published on January 31, 2020.

Smith MJ, Upshur REG, Emanuel EJ. Editorial. Publication Ethics During Public Health Emergencies Such as the COVID-19 Pandemic. Am J Public Health 2020;110(7):947-948. doi: 10.2105/AJPH. 2020.305686.

Persad G, Emanuel EJ. The Ethics of CO- VID-19 Immunity-Based Licenses (“Immunity Passports”). JAMA 2020;323(22):2241-2242. doi: 10.1001/jama.2020.8102.

Kirkcaldy RD, King BA, Brooks JT. COVID-19 and Postinfection Immunity. Limited Evidence, Many Remaining Questions. JAMA 2020;323(22):2245-2246. http://doi: 10.1001/jama.2020.7869.

Ferguson NM, Laydon D, Nedjati-Gilani G, Imai N, Ainslie K, Baguelin M. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand, Imperial College COVID-19 Response Team, London. 2020. https:// www.imperial.ac.uk/media/imperial-co- llege/medicine/sph/ide/gida-fellowships/ Imperial-College-COVID19-NPI-mode- lling-16-03-2020.pdf

Metzl MJ, Maybank A, De Maio F. Responding to the COVID-19 pandemic. The need for structurally competent health care system. JAMA 2020;324(3):231-232. doi: 10.1001/jama.2020.9289.

Dunham AM, Rieder TN, Humbyrd CJ. A bioethical perspective for navigating moral dilemmas amidst the COVID-19 pandemic. J Am Acad Orthop Surg 2020;28(11):471- 476. doi: 10.5435/JAAOS-D-20-00371.

Miles SH, Laar AK. Bioethics North and South: Creating a common ground. Ethics Med Public Health 2018;4:59-64. https://doi.org/10.1016/j.jemep.2017.12.004.

Gandhi M, Yokoe D, Havlir D. Editorial. As- ymptomatic transmission, the achilles´heel of current strategies to control Covid-19. N Engl J Med 2020;382(22):2158-2160. doi: 10.1056/NEJMe2009758.

Wei WE, Li Z, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23– March 16, 2020. MMWR Morb Mortal Wkly Rep 2020;69(14):411-415. doi: 10.15585/mmwr.mm6914e1.

Comisión Interamericana de Derechos Humanos (CIDH). Pandemia y Derechos Humanos en las Américas. Resolución 1/2020, 10/04/2020. http://www.oas.org/es/cidh/ decisiones/pdf/Resolucion-1-20-es.pdf.

Nuffield Council on Bioethics. Ethical Considerations in Responding to the COVID-19 Pandemic. 2020. Available from: https://www.nuffieldbioethics.org/assets/ pdfs/Ethical-considerations-in-respon- dingto-the-COVID-19-pandemic.pdf. Con- sultada, 20 May 2020.

Isaacs D, Britton PN, Preisz A. Ethical reflections on the COVID-19 pandemic: The epidemiology of panic. J Paediatr Child Health 2020;56(5):690-691. doi: 10.1111/ jpc.14882.

Velavan TP, Meyer CG. Editorial. The Covid-19 epidemic. Trop Med Int Health 2020, 25 (3), 278-280.

Global Health Security Index. Johns Hopkins Center for Health Security. 2019. Available from https://www.ghsindex.org. (Consultada, abril 27, 2020).

Velásquez G, Padrón-Nieves M, Piña E, Nézer de Landaeta I, Lizarraga P, Silva S, Lombardi MA. Caso Venezuela: reflexiones desde la bioética. Rev. latinoam. Bioet 2019;19(37-2):75- 92. doi: https://doi.org/10.18359/rlbi.4705.

Larreal Y. Editorial. Venezuela y su índice de seguridad sanitaria global para afrontar la pandemia del nuevo coronavirus SARS-CoV-2. Invest Clin 2020;61(1):1-3. https:// doi.org/10.22209/IC.v61n1a00.

Beauchamp TL, Childress JF. Principles of Biomedical Ethics 1979. Oxford. Oxford University Press. 314p.

Silva DS. Ventilators-by-Lottery: the least unjust form of allocation in the COVID-19 pandemic, Chest 2020;158:890- 891. doi: https://doi.org/10.1016/j.chest.2020.04.049.

Rosenbaum L. Facing Covid-19 in Italy– Ethics, logistics, and therapeutics on the epidemic’s front line. N Engl J Med 2020;382(20):1873-1875. doi: 10.1056/NE JMp2005492.

Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, Zhang C, Boyle C, Smith M, Phillips JP. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med 2020;382(21):2049- 2055. doi:10.1056/NEJMsb2005114.

Solomon MZ, Wynia MK, Gostin LO. Covid-19 crisis triageoptimizing health outcomes and disability rights. N Engl J Med 2020;383(5):e27. doi: 10.1056/NEJ Mp2008300.

Archard D, Caplan A. Is it wrong to prioritize younger patients with covid-19? BMJ 2020;369:m1509 doi: 10.1136/bmj.m1509.

Truog RD, Mitchell C, Daley GQ. The toughest triageallocating ventilators in a pandemic. N Engl J Med 2020;382(21):1973-1975. doi: 10.1056/NEJMp2005689.

Raith EP, Udy AA, Bailey M, McGloughlin S, MacIsaac C, Bellomo R, Pilcher DV, Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE). Prognostic accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317(3):290–300. doi:10.1001/ jama.2016.20328.

Kirkpatrick JN, Hull SC, Fedson S, Mullen B, Goodlin SJ. Allocating scarce resources and triaging patients during the COVID-19 pandemic. J Am Coll Cardiol 2020;76:85-92. https://doi.org/10.1016/j. jacc.2020.05.006.

SIAARTI. Clinical ethics recommendations for the allocation of intensive care treatments, in exceptional, resource limited circumstances. [consultado 1 Sept 2020]. Disponible en: http://www.siaarti. it/SiteAssets/News/COVID19%20-%20do- cumenti%20SIAARTI/SIAARTI%20-%20Covid-19%20-%20Clinical%20Ethics%20Rec- comendations..pdf Acceso.

Martin-Fumadó C, Gómez-Durán EL, Morlans-Molina M. Consideraciones éticas y médico-legales sobre la limitación de recursos y decisiones clínicas en la pandemia de la COVID-19. Rev Esp Med Legal. 2020;46(3):119-126.

Rubio O, Estella A, Cabre L, Saralegui-Reta I, Martin MC, Zapata L, Esquerda M, Ferrer R, Castellanos A, Trenado J, Amblas J. Recomendaciones éticas para la toma de decisiones difíciles en las unidades de cuidados intensivos ante la situación excepcio- nal de crisis por la pandemia por covid-19: revisión rápida y consenso de expertos. Med Intensiva 2020;44(7):439-445. https://doi. org/10.1016/j.medin.2020.04.006.

Matheny Antommaria AH, Gibb TS, Mc- Guire AL, Wolpe PR, Wynia MK, Applewhite MK, Caplan A, Diekema DS, Hester DM, Soleymani Lehmann L, McLeod-Sordjan R, Schiff T, Tabor HK, Wieten SE, Eberl JT, for a Task Force of the Association of Bioethics Program Directors. Ventilator triage policies during the COVID-19 pandemic at U.S. hospitals associated with mem- bers of the Association of Bioethics Program Directors. Ann Intern Med 2020;173:188- 194. doi:10.7326/M20-1738.

Sociedad Colombiana de Oftalmología. Recomendaciones de la Academia Nacio- nal de Medicina de Colombia para enfrentar los conflictos éticos secundarios a la crisis de Covid-19 en el inicio y mantenimiento de medidas de soporte vital avanzado. Bogotá, Mayo 14 de 2020 https:// socoftal.com/documentacion-cursos/Con- flictos%20e%CC%81ticos%20frente%20 a%20Covid%2019.pdf

Savulescu J, Cameron J, Wilkinson D. Equality or utility? Ethics and law of rationing ventilators. Br J Anaesthes. https:// doi.org/10.1016/j.bja.2020.04.011.

Wu Z, McGoogan J M. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China. Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648.

Pan A, Liu L, Wang C, Guo H; Hao X, Wang Q, Huang J, He N, Yu H, Lin X, Wei S, Wu T. Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China. JAMA 2020;323(19):1915- 1923. doi: 10.1001/jama.2020.6130.

WHO/PAHO. www.Paho.org/es/tag/enfer-medad-por-coronavirus-covid-19. Consultada el 8/4/2020.

Ing EB, Xiu Q, Salimi A, Torun N. Physician deaths from Corona virus disease (COVID-19). Occup Med (Lond) 2020; 70(5):370-374. doi:10.1093/occmed/kqaa 088.

Wang J, Zhou M, Liu F. Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect 2020;105:100-101, https://doi.org/10.1016/j.jhin.2020. 03.002.

Francis Bakewell F, Pauls MA, Migneault D. Ethical considerations of the duty to care and physician safety in the COVID-19 pandemic. Canadian J Emerg Med 2020;22(4):407-410. doi:10.1017/cem. 2020.376.

Harkin DW. Covid-19: balancing personal risk and professional duty. BMJ 2020;369:m1606 doi: 10.1136/bmj.m1606.

McConnell D. Balancing the duty to treat with the duty to family in the context of the COVID-19 pandemic. J Med Ethics 2020;46(6):360-363. doi: 10.1136/medethics-2020-106250.

Dunn M, Sheehan M, Hordern J, Turnham HL, Wilkinson D. ‘Your country needs you’: the ethics of allocating staff to high-risk clinical roles in the management of patients with COVID-19. J Med Ethics 2020;46(7):436-440.doi: 10.1136/medethics- 2020-106284.

Morley G, Grady C, McCarthy J, Ulrich CM. Covid-19: Ethical challenges for nurses. Hastings Cent Rep 2020;50(3):35-39. doi: 10.1002/hast.1110.

Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxi- ety among health care professionals dur- ing the COVID-19 pandemic. JAMA 2020 2;323(21):2133-2134. doi: 10.1001/jama.2020.5893.

Pfeferbaum B, North CS. Perspective. Mental health in COVID-19 pandemic. N Engl J Med 2020; 383:510-512. doi: 10.1056/NE- JMp2008017.

The Belmont Report. https://www.hhs. gov/ohrp/regulations-and-policy/belmont- report/read-the-belmont-report/index. html (consultada Mayo 21, 2020).

Organización Mundial de La Salud: https://www.who.int/news-room/commen- taries/detail/off-label-use-of-medicines-for- covid-19. Consultada Agosto 3,2020.

Kalil AC. Treating COVID-19-Off-Label drug use, compassionate use, and randomi- zed clinical trials during pandemics. JAMA. 2020;323(19):1897-1898. doi: 10.1001/ jama.2020.4742.

Retsas S. Clinical trials and the COVID-19 pandemic. Hell J Nucl Med 2020; 23(1): 4-5.

Nature. Editorial: Coronavirus drugs trials need scale and collaboration Nature 2020; 581:120 (Consultada, Mayo 22, 2020).

Callaway E. Hundreds of people volunteer to be infected with coronavirus. Nature 2020 Apr 22. doi: 10.1038/d41586-020-01179-x. (Consultada, Mayo 22,2020).

Shah SK, Miller FG, Darton TC, Duenas D, Emerson C, Fernandez Lynch H, Jamrozik E, Jecker NS, Kamuya D, Kapulu M, J Kimmelman K, MacKay D, Memoli MJ, Murphy SC, Palacios R, Richie Tl, Roes- tenberg M, Saxena A, Saylor K, Selgelid MJ, Vaswani V, Rid A. Ethics of controlled human infection to study COVID-19. Science 2020. 10.1126/science.abc1076,2020.

Coleman CH. Equitably sharing the benefits and burdens of research: Covid-19 raises the stakes. Ethics Human Res 2020;42: 1-3. doi: 10.1002/eahr.500055.

Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic treatments for coronavirus disease 2019 (COVID-19). A Review. JAMA. 2020;323(18):1824-1836. doi: 10.1001/jama.2020.6019.

WHO. https://www.who.int/news-room/ detail/24-04-2020-global-leaders-unite-to- ensure-ever yone-ever ywhere-can-access- new-vaccines-tests-and-treatments-for-co- vid-19. April 28, 2020.

Meagher KM, Cummins NW, Bharucha AE, Badley AD, Chlan LL, Wright RS. COVID-19 Ethics and research., Mayo Clin Proc 2020;95(6):1119-1123, doi: https:// doi.org/10.1016/j.mayocp.2020.04.019.

Esparza J. COVID-19: Una pandemia en pleno desarrollo. Gac Med Caracas 2020; 128(1):1-7.

Berlinger N, Wynia M, Milliken A, Cohn F, Guidry-Grimes LK, Bruce L, Oei G, Lipman HI, Cheatham C. Responding to Covid-19 as a regional public health challenge. Preliminary guidelines for regional collaboration involving hospitals. The Hastings Center. “http://www. thehastingscenter.org”. April 29, 2020.

Publicado
2021-02-23
Cómo citar
Vizcaíno, G., & Esparza, J. (2021). Perspectiva de los dilemas éticos relacionados con la pandemia COVID-19.: Ethical dilemmas related to the COVID-19 pandemic. A perspective. Investigación Clínica, 61(4), 393-405. https://doi.org/10.22209/IC.v61n4a07