Respect for the patient cannot die in the ICU – 07/21/2021 – Opinion

Arguably, technology has been an important ally, during the pandemic, in shortening distances between people. However, we cannot forget that this same technology can be considered invasive with regard to intimacy and individual will. It is necessary, therefore, that we know how to use it with awareness and respect.

In this context, the use of digital resources aimed at communication between patients and families is an important issue for the Regional Council of Medicine of the State of São Paulo (Cremesp), which recently published resolution No. 347, responsible for regulating video calls, not just in the context of Covid-19, but in general.

The regulation determines that the assisted person can carry out virtual visits – if that is their wish – as long as the privacy of others is respected and that they can also designate a representative, who will be responsible for communicating to the physician the desire to have or not the transmitted image, if loss of ability to consent occurs.

If, by chance, the patient does not make this choice, the professional must use the advance directives of will, which must be recorded in the medical record prior to the loss of their ability to consent, to decide whether or not they would like to participate in video calls. With this, it is possible to know the real desire even of sedated patients.

Resolution No. 347 defends the bioethical principle of autonomy and preserves the confidentiality of the doctor and the patient —one of the pillars of the doctor-patient relationship— as defended by the Code of Medical Ethics, ensuring that the use of the digital is done ethically and respectful, without prejudice to the professional team and to others assisted who do not wish to have their image disclosed.

The document seeks to make this resource viable so that the fundamental rights of the patient are preserved, especially autonomy, privacy and confidentiality. Therefore, it is not a question of banning video calls. Allowing its use is an act of dignity and humanity, but only if the patient consents.

His will must always prevail, including respect for privacy, dignity and secrecy, which guide a dignified and humane medicine. It is also necessary to take into account respect for the confidentiality of other patients, hospitalized in the same ICU environment.

It should be emphasized that the regulation refers substantially to medical conduct, since there is a constitutional delegation of the public power, through Law No. 3.268/57, which, in its 15th article, determines that it is the responsibility of the councils regional medical authorities oversee the exercise of the profession.

Recently, Bill No. 2136/20 was approved by the Chamber of Deputies —now being analyzed by the Federal Senate—, which is in line with Resolution No. 347 by determining that “virtual meetings” can take place, provided that it is respected the appropriate time defined by the professional body. It also defines that, if the patient is unconscious, video calls can be made only if he has expressed that this was his will before the loss of the ability to consent, or with the authorization of his family.

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