Rechazo o negativa a tratamientos. Nuevo Código Civil y Comercial, artículo 59 inc. G.

Rechazo o negativa a tratamientos. La contra cara del Consentimiento

-Por la Dra. Lida Sanmartín *-

Otro ejemplo del respeto al principio bioético de la autonomía de la voluntad, como condición humana irrenunciable y su ejercicio íntegro es el reconocimiento en el inc. “g” del rechazo de tratamientos o procedimientos en enfermo terminales como contracara del consentimiento informado habilitante para el facultativo a realizar su labor.

El artículo en su inc. G establece que cuando frente a supuestos de irreversibilidad del cuadro clínico o por la gravedad de las lesiones sufridas lo tornen incurable y no sea factible una mejoría en la salud tiene el paciente el derecho a rechazar “[…]procedimientos quirúrgicos, de hidratación, alimentación, de reanimación artificial o al retiro de medidas de soporte vital”, cuando estos fueran extraordinarios, desproporcionados o ineficaces respecto de la mejoría, máxime si incluyeran un “sufrimiento desmesurado, o tengan por único efecto la prolongación en el tiempo de ese estadio terminal irreversible e incurable.”

Este derecho encuentra sustento en la siguiente normativa: el art. 19 de la C. N., art. 19 de la Ley 17.132 sobre ejercicio de la medicina, la Ley 26.529 y su modificación Ley 26.742 (“Derechos del Paciente en su relación con los Profesionales e Instituciones de Salud” que incorporó los arts. 1° inc. “e” tercer párrafo sobre la autonomía de la voluntad y el art. 5° inc. “g” sobre consentimiento  informado entre los derechos de los pacientes). Así como también del reconocimiento en jurisprudencia de la Suprema Corte en fallos relacionados con pacientes testigos de Jehová, por ejemplo. Lo mismo sucede con el artículo siguiente.

El derecho al arrepentimiento respecto del consentimiento otorgado es reconocido aquí, frente a circunstancias extremas. Colisionan para los profesionales aquí dos esferas, la jurídica y la ética, para los profesionales de la salud impera el criterio de beneficencia y en base a ello tienen el poder de decidir que es menos malo para su paciente (criterio paternalista) y por otro lado los derechos del paciente basado en el principio de autonomía de la voluntad.

Tiene lógica, pues si el paciente habiendo sido cabalmente informado sobre su salud, la terapéutica indicada y todas las posibilidades tomó una determinación, aceptando con ella los devenires y los posibles desenlaces, también podrá frente a ellos decidir conscientemente terminar con un padecimiento incensario; es entonces el rechazo la contrapartida al consentimiento inicial.

¿Porqué debiéramos suponer que solo al inicio de la relación médico paciente está presente -por parte del primero- la aceptación de la autonomía y libre determinación de la voluntad del segundo y no así al final de esta?

El dilema entre los profesionales de la salud es más ético que jurídico, sin perjuicio de reconocer que temen acompañar decisiones unilaterales de sus pacientes por los eventuales reclamos que hagan sus familiares. Ahora bien, no es novedosa la situación en tanto que la Ley de Ejercicio de la Medicina y profesionales auxiliares -otrora sancionada- y aún vigente dispone: Artículo 19: “Los profesionales que ejerzan la medicina, sin perjuicio de lo que establezcan las demás disposiciones legales vigentes, están obligados a (…) Inc. 3:  Respetar la voluntad del paciente en cuanto sea negativa a tratarse o internarse, salvo los casos de inconsciencia, alienación mental, lesionados grave por causa de accidentes, tentativas de suicidio o de delitos”.

Entre los profesionales médicos sin embargo -ante reclamaciones civiles en la práctica- surge como necesaria la observancia de condiciones de forma hermética y sin ellas prefieren la judicialización del tema. Estas condiciones son: que quien toma la decisión sobre “su salud” sea mayor de edad, competente, en su sano juicio, al que se brindó información adecuada, clara y completa, sobre la naturaleza, estado, los riesgos y beneficios del estudio o tratamiento indicado, las alternativas y las consecuencias, y los riesgos de rechazarlo. Que la negativa a someterse al tratamiento sea un acto ajustado al proceso previo de discernimiento y sin coerción por parte de un tercero, sea o no un familiar.

Entendemos los reparos del personal de salud frente al caso, por ello consideramos fundamental ejercer docencia, capacitar a unos y otros en la compleja relación salud enfermedad. Es fundamental aceptar que hoy no es central solo la patología y su terapéutica sino también el conocimiento por parte de todos(los pacientes, sus familiares, apoyos, efectores y profesionales de salud) sobre el proceso de la formación de la voluntad, hasta llegar al CI a la hora de tomar una decisión, entendiendo que esta será tomada, valorada y ejecutada priorizando principios éticos y reforzando los canales de comunicación del equipo médico y los pacientes de manera clara, eficiente y concreta sobre la realidad de la salud de quién deba someterse a atención medica o a investigaciones.


Referencias de la autora: Abogada. Asesora. Derecho Universitario. Derecho a la Salud. Facilitadora en temas de derecho Sanitario. Especialista en Administración del Sector Público. Asesora de la Secretaría Asistencial de APUBA.  Consultoría de Trabajadores y trabajadoras universitarios del área asistencial. Estudio comparativo, planificación y proyección de reglamentaciones. Capacitación sector Asistencial. Ex Directora de Personal Universidad de Buenos Aires, Facultad de Ciencias Médicas. Dirección de Personal. Áreas de dependencia: DG Administración y Secretaria de Hacienda.

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