TITLE: THE RIGHT OF EMERGENCY
Session: Theme articles ‘’Youth and Health Emergencies’’
Hellen Camila Marafon¹, Camila Pereira Ramos², Emanuely dos Santos Silva³, Lucas Bado4, Caio Eduardo Alves de Oliveira Paes Leme Goulart5, Gabriele Montipó6, Carlos Frederico de Almeida Rodrigues7.
¹ Universidade Estadual do Oeste do Paraná – UNIOESTE, campus Francisco Beltrão, Francisco Beltrão, Brazil. E-mail: [email protected]
² Universidade Estadual do Oeste do Paraná – UNIOESTE, campus Francisco Beltrão, Francisco Beltrão, Brazil.
³ Universidade Estadual do Oeste do Paraná – UNIOESTE, campus Francisco Beltrão, Francisco Beltrão, Brazil.
4 Universidade Estadual do Oeste do Paraná – UNIOESTE, campus Francisco Beltrão, Francisco Beltrão, Brazil.
5 Universidade Estadual do Oeste do Paraná – UNIOESTE, campus Francisco Beltrão, Francisco Beltrão, Brazil.
6 Universidade Estadual do Oeste do Paraná – UNIOESTE, campus Francisco Beltrão, Francisco Beltrão, Brazil.
7 Universidade Estadual do Oeste do Paraná – UNIOESTE, campus Francisco Beltrão, Francisco Beltrão, Brazil.
Conflicts of Interest: the authors declare that there are no conflicts of interest.
THE RIGHT OF EMERGENCY
Emergency comes from the latin emergentia, which means emergent action; critical situation, dangerous or fortuitous event, incident¹. Therefore, in the emergency department, the physician must provide care with agility, precision and accuracy of diagnosis, aiming to minimize the risks to that patient’s life. However, very often, there are situations that test not only the doctor’s technical knowledge, but also the scope of their study in ethics, especially bioethics. Issues regarding criteria for access to care (triage); treatment limits, extraordinary measures, futile measures; preservation of privacy and confidentiality², among others, are frequent in this type of care and can be difficult to be answered, especially for young doctors.
Considering that ethics is one of the values preached by the IFMSA and that, as future health professionals, medical students must feel confident to make ethical decisions and defend their patients in all situations, our committee decided to hold a class on bioethics in the emergency medical service. This meeting sought to clarify frequent ethical questions and, mainly, to raise the debate on important issues encountered in this type of care. The class was taught by the Professor of Bioethics at our university, a pediatric neurosurgeon and master of philosophy. After the class, the participants were able to understand the role of the young doctors in the emergency department and how it is necessary not to trivialize this service.
The emergency service must be fast and accurate, which is why, many times, the doctor-patient relationship does not exist, or is asymmetrical, with all the power of decision in the doctor’s hands, in this situations it is common for the patient to be treated without empathy, respect and consideration – he becomes dehumanized by the health system. This is a big issue that we, future doctors, must tackle. It is necessary to understand that every patient deserves to receive the best possible treatment, within ethical and legal limits. In Brazil, the failures in our health care system are even more evident in the emergency room; poor working conditions hinder quality medical care, inadequate remuneration by healthcare professionals increases the chances of medical failure and excessive workload often causes burnout syndrome.
Medicine is a profession at the service of human and community health, so it must be practiced without prejudice or discrimination of any kind. The doctor must act with the utmost care and the best of his professional capacity. For this, it is necessary that there are good working conditions, adequate remuneration and fair hours, allowing the professional to be constantly updated, both in technical and ethical aspects, always being able to indicate the appropriate procedure to the patient.
Hegel, philosopher who dedicated his life to the study of German idealism, says that there are rights whose violation – in favor of superior goods – can be justified³. In the scope of medicine and bioethics, the health professional rules his actions in order not to violate the bioethical principles – non-maleficence, autonomy, justice and beneficence – however, in emergency medicine, this becomes a challenge because it is necessary to balance situations of speed and competence with ethical and legal aspects. In this sense, understanding which rights should be violated, in the aforementioned Hegelian perspective, to guarantee the ideal treatment for the patient, is essential in the application of a more humanized medicine.
Hegel talks about the ‘right to emergency’’, an individual’s right to make an exception in his or her favor in order to achieve justice, in case of extreme need4. Thus, it is understood that the emergency does not invalidate the law, but shows that it is not absolute and that the circumstances of the emergency room can modify the standard medical practice. During the lesson, we learned that the limits between what is right and what is wrong are not well defined when it comes to human life, an entity that is too complex and multifactorial to be understood under a dualistic bias. Thereby, the attending physician needs to triage cases based on a careful and technical analysis, that also includes ethical limits, allowing him to recognize the degree of seriousness involved in each situation and the possible consequences of his actions and omissions.
Emergency medicine brings a strong professional identity to the doctor who chooses to pursue a career in this department. In Brazil, it is often the place of choice for the first job, as it enables practical assistance and the exercise of quick thinking. In addition, there is the possibility of accumulating experience in your specialty and in other areas of medicine; working with other trained professionals allows an exchange of knowledge and deep learning. In emergency medicine, it is possible for the young doctor to exercise autonomy of decision and initiative with the professional exchange and consultation of more experienced doctors5.
Therefore, the physician’s professional identity is created from the experiences in the emergency service, and the emergency room team becomes important in shaping the individual’s bioethical values. For this reason, in Brazil, the decline in health care services, mainly in emergency medicine, which is devalued in relation to other areas of the hospital, directly influences the other levels of care, since today’s emergency doctors, tomorrow will be in other sectors, shaping the vision and treatment with the patient according to what they experienced in the emergency room: loss of dignity and no doctor-patient relationship.
Bioethics is necessary at these times. A study in emergency medicine focusing on the most human aspects and on the most contradictory debates in medical care, based on ethics and empathy, is vital for the young doctor who will form his professional identity in the emergency room. Under these circumstances, he will be capable of understanding that medicine thrives from humanized views and is enabled to deal not only with serious injury, but with organ donation, the relocation of resources, the use of extraordinary measures, human life in all its complexity.
Finally, we concluded the lecture with a holistic understanding of what bioethics is in the emergency department and how it extends to all aspects of medical care. Even though it is not materialized in the emergency room, nor is it a technique learned during practical classes, Bioethics exists in every medical action on the patient. There are no outpatient clinics, wards or emergency rooms for Bioethics. It is in these environments, however, that it should be more present. Developed in the hands of technically and humanly trained professionals, open to the triad of good doctor-patient relationships: rigor in argumentation, openness to the unknown and tolerance for opinions and adverse moments.
¹ Holanda, A. B (1975). ‘’Novo dicionário da língua portuguesa’’. Rio de Janeiro: Nova Fronteira.
² Goldim, J. R. ‘’Aspectos Éticos da Assistência em Situações de Emergência e Urgência’’. Last modified February 6, 2003. https://www.ufrgs.br/bioetica/emergen.htm.
³ Hosle, V. (2007). O sistema de Hegel: o idealismo da subjetividade e o problema da intersubjetividade. São Paulo: Edições Loyola.
4 Goldim, J. R. ‘’Moralidade e Eticidade em Hegel’’. Last modified January 17, 2003. https://www.ufrgs.br/bioetica/tweber.htm#emerg%C3%AAncia.
5 Deslandes, S. F (2001). Frágeis deuses: profissionais da emergência entre os danos da violência e a recriação da vida. Rio de Janeiro: FIOCRUZ.
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