Bioethical and human rights considerations in the selection process for health care for patients with COVID1-9

Summary

This text aims to reflect on the importance of the role played by bioethics and human rights in the selection processes for health care, in terms of critical hospital medicine, for patients suffering from SARS-CoV-2, or Covid-19. To this end, philosophical, theoretical, and empirical elements are taken from various online sources in the areas of the social sciences and health economics.

The essential importance of the right to health is undeniable, and manifests itself in two aspects: the individual and the social. In spite of being an absolute right, however, its exercise and enjoyment depend on the general conditions of society (Varela & Sotelo, 2000). In the case of human rights, the right to health corresponds to second-generation rights, which refer, according to Mexico’s National Human Rights Commission, to those “inherent to human nature, without which one cannot live as a human being” (CNDH, 1992).

Supported since 1946 at an international level by the World Health Organization and also figuring in the Mexican constitution, where one of its main characteristics is nondiscrimination, the right to health is considered both a good and a universal value, as well as an inalienable and non-renounceable right, which the government is required to ensure. This approach is not alien to bioethics, which places the human being at the center of universal interest in medical practice, whose main principles include autonomy, beneficence, non-maleficence, and justice. “In global terms, bioethics has positioned itself as an inter- and multidisciplinary task that promotes an integral approach to health, in order to address the tensions and conflicts derived from the clash of values among cultures, weighing both individual and collective interests and emphasizing the protection of groups in conditions of vulnerability” (Secretaría de Salud, 2020).

In the case of the current global health crisis caused by Covid-19, and according to the Bioethics Guide for the Allocation of Limited Resources for Critical Medicine in Emergency Situations, issued by the Mexican Ministry of Health (2020), most daily medical practice during a health emergency should be subordinated to the practice of public health, since this is the discipline that has the basic tools to reorganize the entire health field and to confront the emergency in accordance with principles of justice. Multidisciplinary teams of health experts can determine how scarce resources are to be allocated and can prioritize the care of patients who require hospitalization for their critical care, deciding on the selection of patients who should receive care in critical medicine or intensive care, which implies the use of extreme measures to preserve life, given the aggressiveness of the disease. To put this in context, we might note that, toward the end of December 2019, an outbreak of pneumonia in the city of Wuhan (Hubei Province, China) was reported internationally, putting local health authorities on alert, who subsequently confirmed the cause: a new coronavirus (WHO, 2020).

On 12 March 2020, an official declaration of the Covid-19 pandemic was made in Mexico, indicating that the management of the pandemic would be carried out under the guidelines of bioethics. Subsequently, on April 30th, the aforementioned Bioethics Guide for the Allocation of Limited Resources for Critical Medicine in Emergency Situations was published. Its objective is to constitute “a bioethics guide to provide criteria guiding triage decisions when a public health emergency generates demand on critical medicine resources that cannot be met.”

Currently, there are approximately 35 million confirmed cases of Covid-19 in the world, and more than a million deaths: figures that exponentially exceed the number of doctors, hospitals, and supplies per person in the world. This has led governments to take drastic measures with respect to medical care. In some cases, the bioethical decisions forced on governments and health authorities with respect to the dignity of infected patients have been questioned.

Mexico has not been exempt from this emergency, with close to 80,000 deaths, hundreds of thousands of infected people, and scarce resources to face the challenge. Although the official information provided by the Mexican government refers to control of the disease, whose indicators include the number of hospital beds occupied and the number of active cases, the veracity of the data has been questioned, as have government strategies for addressing the emergency through the public health system. There has been little clarity regarding bioethical positions and human rights.

Without a doubt, we are facing an unprecedented event in modern history, which can only be compared to the great epidemics of centuries past. In our own era, in spite of technological advances, there are doubts and uncertainty about how societies throughout the world are taking radical measures against the pandemic, even though these may threaten human rights, privacy, and ethical standards, especially in relation to the most vulnerable. In the face of these circumstances, it is worthwhile to bear in mind the words of the Director-General of UNESCO: “This crisis demands the best in humanity, with ethical principles as our compass.”

By Way of Conclusion

It is the duty of the Mexican government and health authorities not only to provide individuals with comprehensive health care and the means to address the pandemic, regardless of age, gender, social or cultural background, beliefs, etc., but also to reevaluate the situation derived from this health emergency and to learn from the global crisis, so that alternatives to emergency measures that may violate people’s human rights can be considered, prioritizing human dignity above any other material criteria. This would require that the mercantilist approach to public health becomes obsolete, with the application of the principles of human rights and bioethics to actions related to the health and well-being of the population. Both disciplines must be totally aligned and must be the basis for positioning rights, without which society runs the risk of degradation and involution in the broadest human sense.

References

•National Human Rights Commission (1992) Regulations of the Law of the National Human Rights Commission, Mexico. CPEUM (1917) Political Constitution of the United Mexican States (CPEUM), Mexico •World Health Organization (1946) Constitution of the World Health Organization. •World Health Organization (2020) COVID-19: chronology of WHO action, Declaration. •Ministry of Health (2020) The Bioethics of the COVID-19 Pandemic, National Bioethics Commission. Mexico City, Mexico. •Fumadó, C. M., Durán, E. L. G., & Morlans, M. (2020). Ethical and Medico-Legal Considerations on Resource Constraints and Clinical Decisions in the COVID-19 Pandemic. Spanish Journal of Forensic Medicine: organ of the National Association of Forensic Physicians, 46(3), 119-126. •Varela H., & Sotelo G., (2000) Derecho y Salud: Instituciones, Paper presented at the Symposium “Derecho y Salud”, in the module “Institutions”, Instituto de Investigaciones Jurídicas de la UNAM, Mexico, DF.

Dr. in C. Tonatiuh González Heredia

Coordinator of the Doctorate in Multidisciplinary Health Research, Research Professor “A”, University Center of Tonala, University of Guadalajara

Mtra. Patricia Elizabeth Silva Colunga

B.A. in Marketing, M.A. in Occupational Health Sciences, Ph.D. student in human rights. University Center of Tonala, University of Guadalajara.