Tuesday, March 19, 2019

It is a medical shame: How Cuban doctors were used to coerce Venezuela voters

Nicholas Casey wrote in NY Times about Yansnier Arias who was sent to Venezuela by the Cuban government, one of thousands of doctors deployed to shore up ties between the two allies and alleviate Venezuela’s collapsing medical system. But with President Nicol├ís Maduro’s re-election on the line, not everyone was allowed to be treated.

As per the article a 65-year-old patient with heart failure urgently needed oxygen. But his Cuban and Venezuelan superiors told him to use the oxygen as a political weapon and not for medical emergencies that day. The veto was to motivate and compel patients to vote for the government.
“There was oxygen, but they didn’t let me use it,” said Dr. Arias.

Many tactics were used, from simple reminders to vote for the government to denying treatment for opposition supporters with life-threatening ailments.

The Cuban doctors said they were ordered to go door-to-door in impoverished neighborhoods, offering medicine and warning residents that they would be cut off from medical services if they did not vote for Mr. Maduro.

Many said their superiors directed them to issue the same threats during closed-door consultations with patients seeking treatment for chronic diseases.

As doctors taking care of patients, our guiding principles are “beneficence (act in the best interest of the patient)” and “non maleficence (do no harm)”. These are derived from “physician autonomy”, where a doctor is free to choose the line of treatment that is best for his/her patient. Doctors have an ethical obligation to always act in the best interests of the patients for their well-being and prevent harm to the patients.

Physician autonomy is inherent in the medical profession. No doctor can be told when to treat patients or when to withhold treatment.

Using doctors in this manner is a clear violation of the Universal Principles of Bioethics as embodied in the UNESCO Universal Declaration on Bioethics and Human Rights.

  1. Respect for human dignity, human rights and fundamental freedoms (Article 3.1)
  2. Priority of the interests and welfare of the individual should have priority over the sole interest of science or society (Article 3.2)
  3. Beneficence and nonmaleficence (Article 4)
  4. Autonomy and individual responsibility (Article 5)
  5. Informed consent (Article 6)
  6. Special protection of persons without the capacity to consent (Article 7)
  7. Respect for human vulnerability and personal integrity (Article 8)
  8. Privacy and confidentiality (Article 9)
  9. Equality, justice and equity (Article 10)
  10. Nondiscrimination and nonstigmatisation (Article 11)
  11. Respect for cultural diversity and pluralism (Article 12)
  12. Solidarity and cooperation (Article 13)
  13. Social responsibility and health (Article 14)
  14. Sharing of benefits (Article 15)
  15. Protection of future generations (Article 16)
16.  Protection of the environment, the biosphere and biodiversity (Article 17).

Doctors are professionals and professional autonomy is their right. No one can take away this autonomy from a doctor.

It’s nothing but a medical shame.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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