Experiencia del Comité de Ética Asistencial del Hospital Carlos van Buren entre los años 2007-2020

Background: Clinical Ethics Committees are deliberative groups whose main functions are to assess cases with ethical-clinical conflicts, to generate institutional protocols for preventive purposes, and to train health teams. Aim: To analyze the activity of a clinical ethics committee of a general hospital in the period 2007-2020. Material and Methods: A retrospective analysis of all session records, annual reports, case resolution and documents generated by the Clinical Ethics Committee of Carlos van Buren Hospital in Valparaíso, Chile, between 2007 and 2020, was carried out. Results: On average, 12 cases are analyzed per year. Sixty percent correspond to requests from pediatric units and in 78% of these cases there was at least one neurological disease. In 62% of cases, the main ethical dilemma was adequacy of therapeutic effort, followed by dilemmas related to the exercise of autonomy in 18.2%. In education, two courses are identified aimed to doctors, residents, and other members of the health team. Regarding normative functions, several documents were generated at the request of the Hospital management or in different clinical situations. During COVID-19 pandemia, the active role of the committee was linked to the three main functions, namely evaluating cases, participating in morbidity and mortality meetings for preventive purposes, and issuing guidelines and recommendations for action. The active participation of Pediatric Neurology residents in the Committee, for educational and administrative purposes, stands out. Conclusions: The three main functions described for the ethics committees were exerted by this Committee during the evaluated period. The impact of our recommendations remain to be objectively evaluated.

A experiência do comitê de bioética de um hospital público / The experience of the Bioethics Committee from a public hospital / La experiencia del Comité de Bioética de un hospital público

Resumo O objetivo deste estudo foi analisar e sistematizar a experiência do comitê de bioética do Hospital Geral de São Mateus, hospital público estadual de São Paulo. Foi adotada metodologia qualitativa de pesquisa, com estratégia de estudo de caso. Duas técnicas de pesquisa foram utilizadas: análise documental e questionário com perguntas abertas aplicado aos participantes do comitê de bioética. Por meio da análise do material obtido foram constituídas quatro categorias: histórico e evolução do comitê; motivação para participar dele; casos marcantes ali discutidos; sugestões para aperfeiçoamento do comitê. Verificou-se que, além de discutir e deliberar, o comitê de bioética desenvolveu também papel educativo em relação aos profissionais e equipes envolvidos. Esse papel foi expandido para a instituição como um todo, por meio de simpósios com temas ligados à bioética. O estudo revela a importância de estimular a criação de instâncias desse tipo nas instituições de saúde do Brasil.

Abstract The objective of this study was to analyze and systematize the experience of the bioethics committee from the Hospital Geral de São Matheus (General Hospital of São Mateus), which is a public hospital in the State of São Paulo, Brazil. We adopted the qualitative research method, with the case study strategy. Two research techniques were applied: record analysis and an open ended questionnaire answered by the bioethics committee participants. Four categories were established after analyzing the material: history and evolution of the bioethics committee; motivation to participate in the bioethics committee; memorable cases discussed by the committee; suggestions for the improvement of the bioethics committee. It was noted that besides discussing and deliberating, the bioethics committee also developed an educational role for the involved professionals and teams. This role was also expanded to the institution as a whole, by means of symposia with topics related to bioethics. This study reveals the importance of stimulating the creations of such forums in Brazilian healthcare institutions.

Resumen El objetivo de este estudio fue analizar y sistematizar la experiencia del Comité de Bioética del Hospital Geral de São Matheus (Hospital General de San Mateo), hospital público del estado de São Paulo, Brasil. Se adoptó la metodología de investigación cualitativa, con la estrategia de estudio de caso. Se utilizaron dos técnicas de investigación: análisis de documentos y cuestionarios con preguntas abiertas aplicadas a los participantes del Comité de Bioética. A través del análisis del material obtenido se constituyeron cuatro categorías: historia y evolución del Comité; motivación para participar de éste; casos importantes discutidos en el Comité de Bioética; sugerencias para la mejora del mismo. Se encontró que, además de discutir y decidir, el Comité de Bioética también ha desempeñado un papel educativo en relación a los profesionales y a los equipos involucrados. Esta función también se amplió a la institución en su conjunto por medio de simposios sobre temas relacionados con la bioética. El estudio pone de manifiesto la importancia de estimular la creación de tales organismos en las instituciones de salud en Brasil.

Comitê hospitalar de bioética: êxitos e dificuldades / Bioethics Hospital Committee: successes and difficulties

Este trabalho objetiva analisar o funcionamento de um comitê hospitalar de bioética nos três primeiros anos de funcionamento. O estudo foi desenvolvido mediante análise do livro de atas e aplicação de questionário Likert (escala 1 a 6) aos membros. No livro de atas estão registradas 25 das 36 reuniães previstas. Os resultados do questionário mostraram que o comitê assessorou parcialmente os profissionais (média 5,08±0,76), revisou documentos e promoveu formação em bioética aos seus membros (média 5,23±0,83). Houve quase unanimidade quanto à importância e continuação do comitê na instituição (média 5,92±0,28). A promoção de formação em bioética aos demais profissionais foi considerada insuficiente (média 4±1,63), bem como sua divulgação interna (média 4,54±1,20). As principais funçães do comitê foram cumpridas e sua continuidade na instituição foi apoiada. Para solucionar os problemas encontrados propãe-se maior divulgação do comitê na instituição e realização de cursos de bioética aos demais profissionais.

Análisis de una experiencia de consultoría ético clínica en cuidado intensivo / Analysis of a clinical ethics consultation experience in intensive care

Background: Very few patients are presented to ethics committees, and individual ethics consultations are a response to this situation. At the intensive care unit (ICU) in Clínica Alemana, Santiago Chile, an ethics consultation system was organized coordinated with the ethics committee. Aim: To report an evaluation of this ethics consultation system. Material and Methods: Analysis of the frst 50 cases analyzed in the consultation system. Analysis of the responses of intensive care physicians to a questionnaire about the main ethical problems that they face in their work. Results: The consultation system is mainly required by the ICU staff, and reports to the ethics committee. Fifty four percent of patients subjected to consultation were aged over 80 years. The main diagnoses were neurological, oncological or cardiopulmonary problems. The ethical problems identifed were treatment limitation (62 percent), proportionality or futility (42 percent), need of a peaceful death (36 percent), lack of anticipated decisions (28 percent), disagreement between physicians and patient’s family (24 percent), undefined subrogation (14 percent), and abuse of public resources (14 percent). Twenty six of 31 ICU physicians answered the questionnaire, using a 1 (min) to 7 (max.) scale. They found that consultation is helpful for decision making (6.3), useful for improving ethical perception (6.0), supportive for staff (6.5), good for patients (6.3), supportive for families (6.7), and timely performed (5.2). Conclusions: As a complement for the ethics committee’s work, consultation is a valid alternative for ethics counselling and a support for physicians and patient’s families. Its implementation depends on the particularities of each health institution.

Los comités de ética clínica en México: la ambigua frontera entre la ética asistencial y la ética en investigación clínica / Institutional ethics committees in Mexico: the ambiguous boundary between health care ethics and research ethics

OBJETIVO: Identificar los comités de ética de la práctica clínica en México y establecer las posibles implicaciones derivadas de su composición y funcionamiento. MÉTODOS: Estudio transversal descriptivo realizado entre enero y diciembre de 2005. Se envió por correo electrónico una encuesta a todos los hospitales y unidades de medicina familiar del Instituto Mexicano del Seguro Social (n = 437) y del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (n = 167) que contaran con más de 10 consultorios, y a los establecimientos asistenciales más importantes de la Secretaría de Salud de México (n = 15). Los elementos analizados fueron: nombre del comité, fecha en la que fue constituido, estado actual de actividad, composición, funciones y facultades. RESULTADOS: Se identificaron 116 comités con muy diversos nombres, de ellos 101 (87,1 por ciento) estaban activos. Estos comités se crearon entre 1985 y 2006, con un pico entre los años 2004 y 2005. De los comités activos, 59 (58,4 por ciento) se encargaban tanto de los problemas/dilemas éticos relacionados con la práctica clínica como de los proyectos de investigación. De los integrantes, 357 (59,0 por ciento) tenían puestos directivos en el establecimiento al que pertenecía el comité del que eran miembros; predominó la profesión médica (71,5 por ciento), seguida de personal de enfermería (11,9 por ciento). De los integrantes de los comités activos, 77,9 por ciento no había recibido entrenamiento en el campo de la ética. CONCLUSIONES: Puede esperarse que surjan conflictos legales, principalmente en los establecimientos cuyos comités se confieren la autoridad de dictaminar el curso apropiado de una acción. Se requiere un plan integral para estandarizar la composición y los procedimientos de los comités de ética clínica en México y mejorar la preparación de sus miembros.

OBJECTIVE: To identify ethics committees in medical practice in Mexico and possible implications stemming from their composition and functions. METHODS: A cross-sectional descriptive study was conducted from January-December 2005. A survey was sent by e-mail to the hospitals and family medicine centers with at 10 practices within the Mexican Institute for Social Security (Instituto Mexicano del Seguro Social) (n = 437) and the Institute for Security and Social Services for State Employees (Seguridad y Servicios Sociales de los Trabajadores del Estado) (n = 167) and to the Mexican Ministry of Health's most important health care centers (n= 15). The following items were analyzed: name of the committee, date of formation, current status, composition, functions, and level of authority. RESULTS: In all, 116 committees were identified, with various names. Of these, 101 (87.1 percent) were active. The committees were formed from 1985-2006, with a spike occurring in 2004-2005. Of the active committees, 59 (58.4 percent) were charged with ethical problems/dilemmas related to clinical practice as well as those related to research projects. Of the committee members, 357 (59.0 percent) held managing positions in the establishment to which the committee pertained; most were medical professionals (71.5 percent), followed by nursing staff (11.9 percent). Among the members of the active committees, 77.9 percent had not received training in ethics. CONCLUSIONS: Legal conflicts can be expected, mainly within the organizations whose committees have the authority to determine a course of action. An integrated plan is needed that will set standards for the composition and proceedings of Mexico's ethics committees and the improved training of committee members.