Afectación al principio autónomo del consentimiento informado desde la perspectiva del Consejo De Estado, Corte Constitucional y Corte Interamericana de Derechos Humanos, desde el periodo de 2014 a 2020
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Fecha
2022
Autores
Jaimes Maldonado, Leidy Carolina
Castillo Galvis, Sebastian Hernando
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias Jurídicas y Sociales
Facultad de Ciencias Jurídicas y Sociales
Resumen
Antecedentes: El consentimiento informado surge en la relación entre paciente y médico, en la cual es el paciente quien tiene el papel protagónico en dicha relación, de la cual se generan obligaciones y derechos como aquel que asiste al paciente de recibir información oportuna y detallada sobre los procedimientos y tratamientos a los cuales será sometido, para que sea éste quien a partir de un conocimiento previo pueda tomar una decisión sobre su cuerpo; claro está que como toda regla general tiene su excepción y para el caso en concreto se menciona que el consentimiento informado podrá ser omitido en los casos de urgencia vital. (De Brigard, 2004)
A partir de ello, se observa que el consentimiento informado es un deber que no puede ser omitido de ninguna manera ya que vulnera el derecho del paciente a escoger el tratamiento y/o procedimiento de manera libre e informada y que en consonancia conlleva al quebrantamiento del principio de la dignidad humana como principio orientador del Estado Social de Derecho constituido a partir de la constitución de 1991.
Objetivos: El objetivo general del proyecto de investigación consistió en analizar la afectación al principio autónomo del consentimiento informado desde la perspectiva del Consejo De Estado, Corte Constitucional y Corte Interamericana de Derechos Humanos, desde el periodo de 2014 a 2020. Para el correcto desarrollo del objetivo general fue necesario establecer tres objetivo específicos los cuales fueron: i) Estudiar el desarrollo jurisprudencial del principio autónomo del consentimiento informado en la prestación de servicios de salud y su alcance. ii) Establecer los elementos del daño de la afectación al principio autónomo del consentimiento informado a partir de la jurisprudencia del Consejo de Estado; y iii) Identificar las subreglas o elementos en la configuración del daño por parte de la Corte Interamericana de Derechos Humanos en escenarios relacionados con el consentimiento informado.
Metodología: El presente trabajo se realizó a partir de una investigación socio - jurídica toda vez que el objeto de conocimiento es la jurisprudencia de la Corte Constitucional, Consejo de Estado y Corte Interamericana de Derechos humanos de los años 2014 – 2020, en relación con su interpretación y aplicación a casos particulares, así como sus deficiencias y omisiones. Además, se parte del derecho en el ámbito social en relación a sus condiciones y efectos. Esta forma de investigación se encuentra estipulada por Duque, et al. (2018) quienes añaden que lo que se busca es que sean investigados los asuntos de la realidad social en relación con los sujetos que intervienen en la investigación.
Resultados: La Corte Constitucional ha sido enfática en señalar que el consentimiento informado es un principio autónomo en el cual su efectivización lo relaciona directamente con la materialización de múltiples derechos fundamentales.
A partir del análisis jurisprudencial que se ha realizado por parte de la sentencia de la Corte Constitucional, se pretende desatacar que a través de la Sentencia C -405 de 2016 se realiza un especial hincapié en el carácter de vinculatoriedad de los principios de autonomía y su relación directa con el principio autónomo del consentimiento informado, señalando la particularidad de que no pueden ser considerados absolutos destacando nuevamente la teoría de la ponderación de Alexy (1993) en el que uno de los mayores precursores del estudio de los principios legales señala que en múltiples momentos puede existir una colisión entre ellos por tal motivo la necesidad de asignarle unos pesos y aunque bien, está teoría sigue siendo objeto de estudio, no cabe duda que es una gran herramienta que incluso ha sido adoptada por la Corte Constitucional y es que, este principio al tener una estructura tan abstracta, su aplicación en caso de una disyuntiva debe tener un proceso lógico bastante profundo, totalmente contrario a una regla en el que simplemente se utilizan la priorización del principio de legalidad del ordenamiento jurídico colombiano.
Un análisis adecuado de los elementos del daño (condiciones de existencia del perjuicio) va a permitir que se eviten errores que se presentan con gran frecuencia tales como, las causales que se encuentran permitidas legal y jurisprudencialmente tales como las causales que permiten realizar un procedimiento sin el consentimiento del paciente, casos que son específicos y que se deben encontrar debidamente soportados. Un ejemplo claro de ello es cuando el paciente se encuentra en medio de una intervención quirúrgica de emergencia, en la que como consecuencia de ello se encuentra en un estado inconsciente bien sea por criterios de anestesia o cualquier otra situación. En estos casos el Consejo de Estado (2017) ha sido enfático al manifestar que cuando el médico encuentre la urgencia de realizar una operación a un paciente que se encuentra en estado inconsciente y dicho procedimiento resulta imprescindible resultaría contrario a una práctica adecuada de la medicina impedir tal procedimiento por falta del consentimiento informado, haciendo la salvedad que el máximo tribunal de lo contencioso administrativo manifiesta la importancia de que en caso de que estén presentes los familiares reciban autorización de ellos.
Conclusiones: Teniendo en cuenta el Control de Convencionalidad existente la Corte Interamericana de Derechos Humanos, respecto al bloque de constitucionalidad en sentido estricto Colombia debe trabajar de forma armónica con los postulado de la Convención y a partir de ello se observa en la jurisprudencia de la CIDH que el consentimiento informado es catalogado como un Derecho Humano de especial protección y su omisión o inadecuada realización conlleva un daño antijurídico a reparar.
El modelo paternalista del médico que anteriormente existía ha perdido total vigencia en razón que el paciente en la relación médico – paciente tiene una connotación protagónica y prueba de ello es la importancia de su consentimiento para la realización de cualquier tratamiento o procedimiento.
Respecto a la Jurisprudencia del Consejo de Estado se encuentra que establece como régimen de imputación subjetivo por falencias en el Consentimiento Informado como una falla en el servicio, tratándose de responsabilidad médica.
Background: Informed consent arises in the relationship between patient and doctor, in which it is the patient who has the leading role in said relationship, from which obligations and rights are generated, such as the one that assists the patient to receive timely and detailed information about the procedures. and treatments to which he will be subjected, so that he is the one who, based on prior knowledge, can make a decision about his body; It is clear that, like any general rule, it has its exception and for the specific case it is mentioned that informed consent may be omitted in cases of vital urgency. (From Brigard, 2004) From this, it is observed that informed consent is a duty that cannot be omitted in any way since it violates the patient's right to choose the treatment and/or procedure in a free and informed manner and that accordingly leads to the breach of the principle of human dignity as a guiding principle of the Social State of Law constituted from the 1991 constitution. Objective: The general objective of the research project was to analyze the impact on the autonomous principle of informed consent from the perspective of the Council of State, the Constitutional Court and the Inter-American Court of Human Rights, from the period of 2014 to 2020. For the correct development of the general objective, it was necessary to establish three specific objectives, which were: i) To study the jurisprudential development of the autonomous principle of informed consent in the provision of health services and its scope. ii) Establish the elements of the damage of the affectation to the autonomous principle of informed consent based on the jurisprudence of the Council of State; and iii) Identify the sub-rules or elements in the configuration of damage by the Inter-American Court of Human Rights in scenarios related to informed consent. Materials and Methods: The present work was carried out from a socio-legal investigation since the object of knowledge is the jurisprudence of the Constitutional Court, Council of State and Inter-American Court of Human Rights of the years 2014 - 2020, in relation to its interpretation and application to particular cases, as well as its deficiencies and omissions. In addition, it is part of the law in the social sphere in relation to its conditions and effects. This form of research is stipulated by Duque, et al. (2018) who add that what is sought is that the issues of social reality be investigated in relation to the subjects involved in the research. Results: The Constitutional Court has been emphatic in pointing out that informed consent is an autonomous principle in which its implementation is directly related to the materialization of multiple fundamental rights. Based on the jurisprudential analysis that has been carried out by the ruling of the Constitutional Court, it is intended to highlight that through Judgment C -405 of 2016, special emphasis is placed on the binding nature of the principles of autonomy and its direct relationship with the autonomous principle of informed consent, pointing out the particularity that they cannot be considered absolute, again highlighting the weighting theory of Alexy (1993) in which one of the greatest precursors of the study of legal principles points out that in multiple moments there may be a collision between them for this reason the need to assign weights to it and although this theory is still being studied, there is no doubt that it is a great tool that has even been adopted by the Constitutional Court and that is, this principle, having such an abstract structure, its application in case of a dilemma must have a fairly deep logical process do, totally contrary to a rule in which the prioritization of the principle of legality of the Colombian legal system is simply used. An adequate analysis of the elements of the damage (conditions of existence of the damage) will allow errors that occur with great frequency to be avoided, such as the causes that are legally and jurisprudentially permitted, such as the causes that allow a procedure to be carried out without the consent of the patient, cases that are specific and that must be duly supported. A clear example of this is when the patient is in the middle of an emergency surgical intervention, in which, as a consequence, they are in an unconscious state, either due to anesthesia criteria or any other situation. In these cases, the Council of State (2017) has been emphatic in stating that when the doctor finds it urgent to perform an operation on a patient who is unconscious and said procedure is essential, it would be contrary to proper medical practice to prevent such procedure due to lack of informed consent, with the exception that the highest court of administrative litigation states the importance of receiving authorization from family members if they are present. Conclusions: Taking into account the existing Control of Conventionality of the Inter-American Court of Human Rights, regarding the block of constitutionality in the strict sense, Colombia must work in harmony with the postulates of the Convention and from this it is observed in the jurisprudence of the IACHR that the consent informed is classified as a Human Right of special protection and its omission or inadequate performance entails unlawful damage to be repaired. The paternalistic model of the doctor that previously existed has lost all validity because the patient in the doctor-patient relationship has a leading connotation and proof of this is the importance of their consent for the performance of any treatment or procedure. Regarding the Jurisprudence of the Council of State, it is found that it establishes as a regime of subjective imputation for shortcomings in the Informed Consent as a failure in the service, in the case of medical responsibility.
Background: Informed consent arises in the relationship between patient and doctor, in which it is the patient who has the leading role in said relationship, from which obligations and rights are generated, such as the one that assists the patient to receive timely and detailed information about the procedures. and treatments to which he will be subjected, so that he is the one who, based on prior knowledge, can make a decision about his body; It is clear that, like any general rule, it has its exception and for the specific case it is mentioned that informed consent may be omitted in cases of vital urgency. (From Brigard, 2004) From this, it is observed that informed consent is a duty that cannot be omitted in any way since it violates the patient's right to choose the treatment and/or procedure in a free and informed manner and that accordingly leads to the breach of the principle of human dignity as a guiding principle of the Social State of Law constituted from the 1991 constitution. Objective: The general objective of the research project was to analyze the impact on the autonomous principle of informed consent from the perspective of the Council of State, the Constitutional Court and the Inter-American Court of Human Rights, from the period of 2014 to 2020. For the correct development of the general objective, it was necessary to establish three specific objectives, which were: i) To study the jurisprudential development of the autonomous principle of informed consent in the provision of health services and its scope. ii) Establish the elements of the damage of the affectation to the autonomous principle of informed consent based on the jurisprudence of the Council of State; and iii) Identify the sub-rules or elements in the configuration of damage by the Inter-American Court of Human Rights in scenarios related to informed consent. Materials and Methods: The present work was carried out from a socio-legal investigation since the object of knowledge is the jurisprudence of the Constitutional Court, Council of State and Inter-American Court of Human Rights of the years 2014 - 2020, in relation to its interpretation and application to particular cases, as well as its deficiencies and omissions. In addition, it is part of the law in the social sphere in relation to its conditions and effects. This form of research is stipulated by Duque, et al. (2018) who add that what is sought is that the issues of social reality be investigated in relation to the subjects involved in the research. Results: The Constitutional Court has been emphatic in pointing out that informed consent is an autonomous principle in which its implementation is directly related to the materialization of multiple fundamental rights. Based on the jurisprudential analysis that has been carried out by the ruling of the Constitutional Court, it is intended to highlight that through Judgment C -405 of 2016, special emphasis is placed on the binding nature of the principles of autonomy and its direct relationship with the autonomous principle of informed consent, pointing out the particularity that they cannot be considered absolute, again highlighting the weighting theory of Alexy (1993) in which one of the greatest precursors of the study of legal principles points out that in multiple moments there may be a collision between them for this reason the need to assign weights to it and although this theory is still being studied, there is no doubt that it is a great tool that has even been adopted by the Constitutional Court and that is, this principle, having such an abstract structure, its application in case of a dilemma must have a fairly deep logical process do, totally contrary to a rule in which the prioritization of the principle of legality of the Colombian legal system is simply used. An adequate analysis of the elements of the damage (conditions of existence of the damage) will allow errors that occur with great frequency to be avoided, such as the causes that are legally and jurisprudentially permitted, such as the causes that allow a procedure to be carried out without the consent of the patient, cases that are specific and that must be duly supported. A clear example of this is when the patient is in the middle of an emergency surgical intervention, in which, as a consequence, they are in an unconscious state, either due to anesthesia criteria or any other situation. In these cases, the Council of State (2017) has been emphatic in stating that when the doctor finds it urgent to perform an operation on a patient who is unconscious and said procedure is essential, it would be contrary to proper medical practice to prevent such procedure due to lack of informed consent, with the exception that the highest court of administrative litigation states the importance of receiving authorization from family members if they are present. Conclusions: Taking into account the existing Control of Conventionality of the Inter-American Court of Human Rights, regarding the block of constitutionality in the strict sense, Colombia must work in harmony with the postulates of the Convention and from this it is observed in the jurisprudence of the IACHR that the consent informed is classified as a Human Right of special protection and its omission or inadequate performance entails unlawful damage to be repaired. The paternalistic model of the doctor that previously existed has lost all validity because the patient in the doctor-patient relationship has a leading connotation and proof of this is the importance of their consent for the performance of any treatment or procedure. Regarding the Jurisprudence of the Council of State, it is found that it establishes as a regime of subjective imputation for shortcomings in the Informed Consent as a failure in the service, in the case of medical responsibility.
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Palabras clave
Consentimiento, Informado, Responsabilidad, Extracontractual, Derecho, Consent, Informed, Responsibility, Extracontractual, right, Right