DEFENSIVE MEDICINE AND HEALTH JUSTICE

Resumo

Objetive: Defensive Medicine (DM), which began in the 60s and 70s of the 20th century, resurfaces in the face of clinical uncertainty and connects, surprisingly with the authors of the 70s who anticipated its dangers for the quality of care, and the allocation of the resources. It compromises the sustainability of the system and harms the individual patient and the group of patients due to overuse and its logical corollary - the underuse of clinically useful therapies - with the opportunity cost. Its relevance explain this work. Metodology:  A Review of the literature of defensive medicine was carried out. There is no single definition of defensive medicine, even though, one can summarize the effects that these medical practices produce in the health care system, as a problem of public health. At the same time, the conceptual approach is follows by the ethical analize.  To unify the analysis of defensive medicine with the fundamental clinical relationship, it is necessary to account for 1) the presuppositions of the relational perspective, in particular the meaning of health as a right, capacity and safe functioning; 2) of its regulative ideal, which contrasts with that pursued by defensive medicine, and 3) of its distinctive characters at present, in order to facilitate its comparison and evaluation with defensive practice. Resaults: Thus, Defensive Medicine shifts the best interest of the patient to a secondary place, raising the interest of the professional to the foreground, with devastating effects for the health care at divers organizational level: 1) microethics; compromises the good clinical judgment of the professional, wich empties morally and moves away from the internal good of the profession, 2) mesoethics, the quality of care decreases; increases the cost and compromises accessibility, and 3) macroethics, destroys the trust that society deposits in the medical profession by failing to fulfill the purposes that give it legitimacy social, sacrificing other workings of the system.