DIRECTIVAS MÉDICAS ANTICIPADAS. Principio general. Derecho a decidir la no asistencia.

– Por la Dra. Lida Sanmartin –

La dignidad humana reconoce en el ser humano su condición de tal y por el solo hecho de serlo. Por lo tanto esta condición exige que se obedezcan las disposiciones personales y el propio proyecto de vida, siempre que este no perjudique a terceros. En este sentido el Nuevo Código prescribe quién y bajo qué condiciones puede disponer respecto de su salud.

“ARTÍCULO 60.- Directivas médicas anticipadas. La persona plenamente capaz puede anticipar directivas y conferir mandato respecto de su salud y en previsión de su propia incapacidad. Puede también designar a la persona o personas que han de expresar el consentimiento para los actos médicos y para ejercer su curatela. Las directivas que impliquen desarrollar prácticas eutanásicas se tienen por no escritas. Esta declaración de voluntad puede ser libremente revocada en todo momento.”

Esto garantiza el pleno respeto por la autonomía de la voluntad del ser humano y viene a colisionar con el paradigma del médico como figura central -encargado de cuidar de la persona- decidiendo de manera paternalista lo que fuera mejor (según su ciencia y saber) para la salud.

La novedad está dada por el reconocimiento en el paciente de un papel protagónico en la toma de determinaciones, esta norma reconoce la afirmación de su derecho personalísimo de decidir según su sistema de valores, creencias, expectativas; y por tanto lo coloca frente a su tratante médico como supremo decisor, a quién este último deberá respetar – aun en disidencia- respecto de su voluntad.

En ciertas ocasiones nos enfrentamos a situaciones límites en las que no han podido nuestros familiares o nosotros mismos manifestar nuestra voluntad o pretensión respecto de cómo ser tratados en momentos críticos de nuestra salud. Esto sucede de una manera más habitual de lo que imaginamos. Tal lo hemos palpado en el Caso “Marcelo” de resolución en la Corte.

Frente a estos casos es relevante que los familiares -o personas que estén a su cargo- estén al corriente de cuáles son sus disposiciones ante una situación de emergencia y puedan efectivamente transmitirlas a profesionales de la salud -o las instituciones médicas- incluso estos últimos estar enterados formalmente de las decisiones que respecto de la elección de su NO tratamiento.

Estas instrucciones previamente expresadas en pleno uso de sus facultades de manera precisa y por escrito sobre a qué cuidados se someterán o qué prácticas no desean se les apliquen, llegado el caso de que no pudieran expresar su voluntad, se hallan sustentadas en valores personalísimos que hacen a su conciencia y sus convicciones.

Para el profesional contar con ellas tiene como propósito principal conocer con claridad, sin lugar a dudas o cuestionamientos el pensamiento y las ponderaciones o preferencias de su paciente, más allá de lo que opinen familiares, allegados o afines. (Recordemos que en el caso reciente fue una institución religiosa quién planteó las objeciones)

El Artículo 60 del CCyCN sienta un precepto general  de respeto por los derechos personalísimos y los conceptos de bioética reconocidos en el art. 1° y 2° del Código sobre las fuentes y la interpretación que rigen la relación. Por ello entendemos que al decir “La ley debe ser interpretada […] de modo coherente con todo el ordenamiento”  deja expreso que la Ley del Derechos del Paciente y su reglamentación son de aplicación para todo lo que tiene que ver con cómo se emite, ante quién, con qué requisitos mínimos, su revocación, las consecuencias para el profesional tratante, que instrucciones serán nulas, etc.

Un tema que pese a todo lo legislado y la reciente sentencia aún encuentra mucho debate por delante.

Debate que debe ser ampliado, no circunscribirse al final de la vida sino también al “proyecto de vida adulta” de nuestros mayores pues siendo estos personas en pleno uso de sus capacidades pueden adelantarse y siguiendo las palabras del artículo 60 podrían anticipar directivas y conferir mandatos respecto de sus bienes (y la administración de ellos) hasta su muerte, tomando estos recaudos en previsión de su propia discapacidad futura donde seguramente pueden recibir un trato digno y acorde a sus deseos en la plenitud.

Hoy esta posibilidad cae en la órbita del derecho notarial, principalmente en provincia de Buenos Aires.


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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