Knowledge and teaching of human sciences and social sciences in the training of intensive care physicians. ¿Are they necessary today?

The new social dynamics of the 21st century resulting from globalization, ethnic, cultural mixing and now the COVID-19 pandemic require learning and teaching new ways of communicating and behaving with human beings and society. The human and social sciences help in the process of understanding the moral, social and behavioural codes of a population, as well as the human and social aspects of the person;both sciences base their analysis and evaluation on personal, family and social customs. Knowledge and teaching of human and social sciences is achieved through the educational programmes in universities' academic curricula and the skills developed for learning. The purpose of this reflection is to determine the importance of incorporating skills in human and social sciences into the academic curricula of critical medicine and intensive care specialization. Based on the hypothesis that knowledge and teaching of the human and social sciences in the training of intensive care physicians will broaden their personal and social vision, critical thinking and medical understanding in aspects concerning colleagues, patients, families and the plural and diverse society in today's hospitals. © 2022 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Ethical decision in Triage by priorities, approached from a human rights perspective

Triage is a system for selecting and classifying patients in emergency services, based on therapeutic needs and available resources for adequate care. In addition, it differentiates patients, in times of normality where equal justice is applied and in times of emergency, equitable justice is applied. Triage always maintains medical, scientific and ethical criteria even in times of exception or health emergency, such as in the COVID-19 pandemic, avoiding injustices, discrimination, violations or exclusions of patients;always respecting the fundamental right to health and life. It does not change its name or its denomination in times of emergency, only the strategy before the scarce resource, establishing priorities for the distribution and adequate allocation of the resource. Applies distributive justice or social justice and the principle of proportionality what is useful and beneficial for whoever benefits the most. It always takes into account the ethics of public health as the highest social good that must be present in the actions and decisions of those who carry it out. The objective of this reflection article is to establish three questions that give answers to the importance of Triage in the COVID-19 pandemic, related to: Selection and classification;Respect for human rights, and Denomination of Triage. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Holistic view of bioethics in the COVID-19 pandemic

Throughout the history of humanity, there have been epidemics and pandemics, which have generated a climate of uncertainty, and fears that affect health, social and economic matters. The reports issued by international institutions during the COVID-19 pandemic in relation to health, bioethics and the economy, show a very weak link between them, which is highlighted by the vulnerability of fundamental rights in exceptional times and health and life emergencies. Society's disobedience and indiscipline has resulted in greater infections and deaths, which have impacted the safety and well-being of the population. The development of a vaccine may improve this uncertainty and fears of society. Clinical bioethics from ethical principles and patients’ rights should extend knowledge and participation to human rights, universal principles, and actions of society. The COVID-19 pandemic has shown that the existing bioethical frameworks were not designed for a pandemic and this has been noticed. The holistic vision of bioethics integrates social, cultural, environmental, political, and economic issues with life, health, and people in a global and social way, and integrates citizens’ duties and community rights. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Principle of therapeutic proportionality in the decision of orotracheal intubation and invasive mechanical ventilation in patients with serious COVID-19

In medicine, when the principle of therapeutic proportionality is applied, the means used and the foreseeable end in each patient are assessed. A distinction is made between proportionate or disproportionate treatments, assessing the benefit and usefulness. Among them, is its application in the severe COVID-19 patient that requires orotracheal intubation and invasive mechanical ventilation. Sometimes this can lead to the ethical dilemma of carrying out this procedure and not finding any benefit, but on the other hand generate suffering, pain, and prolongation of their possible agony. Having the ethical duty in these cases not to abandon, but to accompany through palliative care, always informing the family members about the decision that is made. Analysing this principle of therapeutic proportionality and its application in intensive care units requires a moral conscience on the part of the group that has the responsibility of making the decision and resolving the ethical dilemma that arises. Bearing in mind that patients who require orotracheal intubation should be offered all the measures required in invasive and non-invasive mechanical ventilation to improve hypoxaemia. An analysis and reflection on the principle of therapeutic proportionality and its ethical foundation is presented, as well as a systematic review of the medical literature related to patients with COVID-19 disease in acute respiratory failure. Some scientific and ethical considerations are also established to take into account in the COVID-19 patient. The principle of therapeutic proportionality before the decision of orotracheal intubation must be based on a judgment of proportionality. To ensure that all foreseeable means have been taken into account and used to avoid orotracheal intubation, and that the only useful purpose to benefit the patient will be invasive mechanical ventilation. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Human rights and social dimension of vulnerable people during the pandemic for the new coronavirus SARS-CoV-2

Introduction: The criteria for hospital admission and the application of the principle of distributive justice in exceptional situations, and emergencies at the peak of a second wave caused by the new coronavirus SARS-CoV-2, must be rethought and reviewed in the light of human rights and the social dimension of the person. Objective: Review the human rights and social dimension of vulnerable people in the pandemic caused by the new coronavirus SARS-CoV-2. Methodology: An analysis and reflection was carried out on human rights and the social dimension of vulnerable people affected with the new coronavirus SARS-CoV-2. Results: Human rights are indivisible and interdependent. This means that they cannot be fully enjoyed if they are not all integrated. Therefore, there is an obligation to respect, protect, and fulfil them. The social dimension of the person is related to quality of life, life cycle, life expectancy, and their social value. The medical concepts that are used interchangeably to identify vulnerable people due to their functional condition are: elderly, comorbidity, frailty, dementia, and disability. However, they are different clinical entities, that are causally related, which cause vulnerability in COVID-19 patients. Discussion: The COVID-19 disease is a serious global challenge that consists of a call to revitalize the universal values contained in international human rights standards. Decisions and practices related to the management of the pandemic must be formulated and implemented based on respect, dignity, rights and human values. Conclusion: Vulnerable people, due to their functional condition, increase the risk of suffering from the COVID-19 disease, as well as the risk of not being admitted to the ICU in times of exception or emergency. An adequate assessment of human rights and the social dimension of the person will ensure that these patients are not discriminated against. © 2020 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Bioethical, scientific, and moral aspects of decision making in the context of scarce resources during the COVID-19 pandemic

Introduction: Health institutions may be faced with an overflow in medical care and a decrease in resources in times of the COVID-19 pandemic. If so, they will have to make decisions based on the principle of distributive justice to benefit those who need it most and thus generate the greatest social good. Objective: To analyse the moral, bioethical, and scientific aspects in the decisions made in the context of scarce resources due to the COVID-19 pandemic. Methodology: An analysis and reflection was carried out on the moral, bioethical, and scientific aspects, based on ethical concepts reported in the medical literature, and issued during the COVID-19 pandemic. Results: For the analysis and reflection, three aspects were taken into account: 1. The moral basis of the decision (moral action, ethical dilemma and conflict of interest, and moral theories). 2. The bioethical basis of the decision (medical profession, hospital ethics committees, clinical ethics, principles of bioethics). 3. The scientific basis for the decision (triage in the pandemic with its priorities, other triage scales). Statistics: Due to the type of reflection study, no statistical measures were used. Conclusion: Moral sensitivity, bioethical reasoning, and scientific knowledge are essential when making decisions in times of the allocation of scarce resources. They will always be accompanying the decision of distributive justice, as regards the respect for the dignity and rights of patients to health and dignified death. © 2020 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo