Cuidados Paliativos. Nuevo Código civil y comercial

-Por la Dra. Lida Sanmartín-

“ARTÍCULO 59.- Consentimiento informado para actos médicos e investigaciones en salud. El consentimiento informado para actos médicos e investigaciones en salud es la declaración de voluntad expresada por el paciente, emitida luego de recibir información clara, precisa y adecuada, respecto a:

Inc. “A” su estado de salud[…]

Inc. “H” :”el derecho a recibir cuidados paliativos integrales en el proceso de atención de su enfermedad o padecimiento.”

Definir los cuidados paliativos es complejo, pues se trata de cuidados integrales que no pretenden alargar la vida o evitar la muerte, sino que a nuestro entender plantean un tránsito digno en ese devenir natural. Según el Instituto Nacional del Cáncer, dependiente del Ministerio de Salud de la Nación “son los cuidados que los equipos de salud brindan a las personas afectadas por enfermedades crónicas, avanzadas o progresivas  como el cáncer u otras (patologías neurodegenerativas, insuficiencia renal, etc.), que están destinados a garantizar el alivio del dolor y del sufrimiento y una  digna calidad de vida.”

            El legislador -en este tema- vuelve a tomar posiciones esgrimidas en el plano internacional y con base en el andamiaje normativo local existente incorpora los cuidados paliativos con total correspondencia a lo establecido en el art. 5 la ley de Derechos de los Pacientes. Es de notar que la ley 26742 al modificar la LDP incorpora respecto de la autonomía de la voluntad, en el artículo 2° inc. “e” párrafo final: “En todos los casos la negativa o el rechazo de los procedimientos mencionados no significarán la interrupción de aquellas medidas y acciones para el adecuado control y alivio del sufrimiento del paciente”.

            Reforzando esta posición el Art 11. del decreto reglamentario 1089/2012 dice: “ante el rechazo de tratamiento por parte del paciente mediante Directivas Anticipadas se encuentre en estadios irreversible, incurable o terminal, en cuyo caso el profesional interviniente mantendrá los cuidados paliativos tendientes a evitar el sufrimiento. En este supuesto, se entiende por cuidado paliativo la atención multidisciplinaria del enfermo terminal destinada a garantizar higiene y confort, incluyendo procedimientos farmacológicos o de otro tipo para el control del dolor y el sufrimiento.” Emerge evidente el carácter humanitario y el reconocimiento de la dignidad humana.

            De acuerdo a la definición brindada por la Organización Mundial de la Salud (OMS 2002), se amplía el concepto:”Cuidados Paliativos es una estrategia que permite aumentar la calidad de vida de los pacientes y de sus familias asistiendo las enfermedades que amenazan la vida, a través de la prevención y alivio del sufrimiento por medio de una temprana e impecable valoración y tratamiento del dolor y de otros problemas, físicos, sicosociales y espirituales”.

            La realidad es que respecto de estos cuidados, no hay reglamentación concreta y si fragmentaciones en lo que refiere a su financiamiento: quién y hasta donde se hará cargo de la cobertura.

Hoy nuestro país lo reconoce como un derecho, incluso como una sub disciplina dentro de la temática de salud, pero no cuenta a nivel general con una norma específica que lo reglamente, pues en 2012 con el número de trámite (S-3873/10) la Cámara de Senadores de la Nación aprobó el proyecto de ley “Plan Nacional de Cuidados Paliativos” cuyo objeto era la implementación de un Sistema Nacional, pero esta idea no prosperó y en la actualidad ha perdido estado parlamentario.

            Tampoco podemos desconocer que en nuestro aglomerado normativo es un derecho contemplado, tal como advertimos al inicio de este punto, lo regla específicamente en el artículo 5° y en el artículo 2° párrafo final del inc. “E” de la ley 26529 modificada por la ley 26742, también en el Programa Médico Obligatorio ampliado del año 2002 incluyéndolo en las prestaciones básicas esenciales donde se acentúa que se torna prioritario desarrollar proyectos que admitan “el derecho a una muerte digna, buscando la desinstitucionalización de estos pacientes cuando sea posible”.

            Es importante – por qué no plausible y alentador- que hoy sea norma positiva, de alcance nacional, dado que la temática es sensible socialmente y no podría ser desconocida por lo trascendente de la tarea que realizan, si consideramos que los cuidados paliativos significan la atención integral de las personas en su realidad total: biológica, psicosocial y espiritual; en todas las fases de la enfermedad a partir la prevención y el diagnóstico, el tratamiento e incluyendo aquellos cuidados del final de la vida. Los objetivos de esta perspectiva son: el bienestar de los pacientes, aliviar sus dolencias y los efectos adversos de los tratamientos, los problemas psicológicos, sociales y espirituales que soportan. Sin embargo su mirada y abordaje no concluye allí sino que se encamina a las vivencias de sus familiares y cuidadores.

            Tal es así que organizaciones internacionales como: la Asociación Europea de Cuidados Paliativos (EAPC), la Asociación Internacional de Cuidados Paliativos (IAHPC), la Alianza Mundial de Cuidados Paliativos (WPCA) y el Observatorio de Derechos Humanos (ODH) han elaborado un documento conocido como la Carta de Praga en la cual urgen a los gobiernos a aliviar el sufrimiento de sus enfermos terminales y a reconocer los Cuidados Paliativos como un derecho humano, expresando que “los Cuidados Paliativos son un abordaje que mejora la calidad de vida de pacientes y familiares que padecen problemas asociados con enfermedades que amenazan la vida, a través de la prevención y alivio del sufrimiento, por medio de la identificación precoz, evaluación de excelencia y el tratamiento del dolor y otros problemas, físicos, psicosociales y espirituales.”


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. Asesora de la Secretaría Asistencial de APUBA y espacio de DDHH- Género. 2004-2014

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