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An Ethical Analysis on a Portuguese Case Study

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Reflexão referente ao Caso Clínico 1
Perante um caso como o que nos foi apresentado, a decisão sobre revelar a informação obtida não deve ser tomada de ânimo leve, pois existem demasiadas variáveis a ter em conta. Da análise em grupo concluímos que existe um claro conflito entre os princípios da Beneficência, Veracidade, Honestidade e Prevenção das mulheres infetadas com o princípio da Autonomia, o dever da Confidencialidade e o sigilo médico para com o parceiro masculino. Além disso, a informação poderá trazer graves consequências relacionais e afectar o estado psicológico dos afetados se for apressada, pelo que o conceito da Não Maleficência (primum non nocere) também esteve decerto envolvido na reflexão a que nos propusemos.
Prosseguindo com a análise, reparamos que, caso o médico não insistisse com o doente do sexo masculino para revelar a sua condição às suas parceiras, poder-se-ia ver assegurado o princípio da Autonomia, pois é dado ao doente o direito de lidar com a doença segundo os seus ideais e as suas convicções e escolher o momento ideal para revelar a informação. No entanto, ao atuar desta forma o médico estaria a pôr em causa os seguintes princípios para as duas parceiras afectadas:
 Beneficência (“salus aegroti suprema lex”), que advoga que as ações dos profissionais de saúde devem ser de acordo com o melhor interesse, o maior bem do doente. Ao ocultar às doentes a situação do parceiro, o médico não estaria a atuar de acordo com o maior bem destas, comprometendo a sua saúde.
Para ambas as doentes do sexo feminino o desconhecimento da situação do parceiro, e consequentemente, da sua própria situação, propicia ainda comportamentos de risco, como a não utilização de preservativos.
 Veracidade, Honestidade e Prevenção: O paciente merece conhecer toda a verdade sobre a sua doença e tratamento, não devendo o médico mentir ao doente ou induzi-lo em erro. O conhecimento da realidade da sua doença poderá ajudar o doente a lidar com ela e prevenir eventuais complicações ou, neste caso, o aparecimento de mais doentes infetados.
Não nos podendo reduzir a um prisma maniqueísta, em que haveria uma decisão moral claramente superior a outra, convém no entanto perceber objetivamente qual o caminho ética e moralmente correto a tomar. Para isso, decidimos analisar o Código
Deontológico da Ordem dos Médicos, onde consta, no Artigo 89º que concerne a precauções que não violam o segredo médico, que “quando o doente tem um comportamento que traz um risco real e significativo para a vida de outra pessoa, o médico tem que tentar persuadi-lo a modificar esse comportamento. No entanto, se mesmo com a persuasão do médico o doente não modificar o seu comportamento, o médico terá então que informar as pessoas em risco, comunicando ao doente que o vai fazer.” Percebemos por isso que não há violação do sigilo médico na revelação da informação, desde que tenha havido, por um lado, uma tentativa prévia em persuadir o paciente para informar e, por outro, assegurar que se comunica ao mesmo que o próprio médico o fará se ele não o fizer. Isto porque é fundamental não quebrar o vínculo de confiança que se havia criado com o doente, desrespeitando assim a sua Dignidade enquanto ser livre e autónomo. Este “humanizar o agir e as relações” médico-doente constitui a base de todo o agir ético e de toda a relação com o outro.

Concluímos, respondendo em concreto às questões do Caso Clínico sob a análise dos princípios fulcrais da Bioética, que o médico nesta situação não deveria revelar de imediato o estado infecioso do parceiro, mas deveria contactar o doente seropositivo e solicitar que revele a sua situação à atual parceira. Caso este se recusasse, advogando o já mencionado artigo 89º do Código Deontológico, o médico ver-se-ia obrigado a avisar o doente que, caso não fosse ele a contar, seria ele mesmo que trataria de o fazer.

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