Ethical conflicts among Spanish internists

Internal medicine doctors Spanish Society of Internal Medicine (SEMI) have met in VII Conference on Bioethics and Professionalism of SEMI, which gathered internists from all over the country in Madrid to discuss and analyze new developments in these fields, with a view to the macro and micro organizational management of covid-19 pandemic from multiple points of view and also on ethical conflicts in Internal Medicine and Professional Burnout.

Regardless of the pandemic situation experienced, it became clear that ethical conflicts or dilemmas are “very common” in the specialty of Internal Medicine. So much so that according to a survey of internists by the SEMI Bioethics and Professionalism Group, 70.1 percent of Spanish internists often or almost always encounter Ethical conflicts in your clinical practice daily (29.9% never or almost never). Furthermore, for 39.9% of internal medicine specialists, these dilemmas “often or almost always” interfere with your clinical work and care, regardless of the arrival of Covid-19 and the changes it has brought to the healthcare system. On the contrary, 60.1% felt that conflicts “rarely or hardly ever” interfered with daily clinical care.

The conference was opened by SEMI President, Jesus Dies Manglanoand from the outgoing SEMI Bioethics and Professionalism WG Coordinator, Diego Real of Asuaand during it, with the participation of experts from multiple fields and disciplines (media, health administration and management…), they reflected on the pandemic and the ethical dilemmas it brought, as well as on the stress and burnout of professionals.

It was the pandemic that raised ethical conflicts on many levels, “not only was the debate about sorting criteria relevant and the impact of age on them, but there was also patient isolation issues (both in hospital, separated from their families and those isolated at home), issues of priority access to research protocols, conflicts over whether to promote closeness with patients’ families at the end of life or prioritize the principle of public health and continuing with strict isolation policies,” as recalled on the day.

The five most common ethical conflicts among internists

During the pandemic, according to data presented at the meeting, “more than 90 percent of health professionals attended Burnout syndrome moderate to severe’. Among the toilets that were on the front line: 45 percent suffered anxiety25 percent depressions38 percent insomnia and 68 percent stress. In addition, health overload has caused “35 percent to feel less satisfied with their jobs, double the pre-pandemic period, as more than 20 percent of them are considering early retirement or reducing their work hours.”

The five ethical conflicts The most common in internal diseases, regardless of the pandemic, are: Limitation of therapeutic efforts in patients with poor clinical status; conflicts over decisions for treatment with palliative intent (including terminal sedation); conflicts over CPR Orders Do not resuscitate; conflicts of communication with relatives of patients and decision-making in patients who they have no power to decide for my self.

In the words of Real de Asua: “Internists, as physicians with a global vision of the patient, have as their primary mission ‘to be referents‘, drivers Y defenders of the patient in his complex trajectory through the current hospital system”, in addition to “acting as consultants and offering innovative aspects in alternative areas of conventional hospitalization”. In this role, one of his main objectives, emphasizes Real de Asúa, “must be the establishment of a culture of care centered on the patient’s values ​​and preferences, which facilitates the search for shared goals between them and health professionals. For this task, open to all health professionals, of course, internists are in an excellent position.”