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• Dying in abandonment during the Covid-19 pandemic: the silent tragedy of misthanasia and the urgent need to avoid it
  Sergio Britto Garcia, Marco Aurelio Guimarães and Waynice Neiva de Paula Garcia
  Published on: 23 July 2020

• Published on: 23 July 2020

  Dying in abandonment during the Covid-19 pandemic: the silent tragedy of misthanasia and the urgent need to avoid it

  • Sergio Britto Garcia, Associate Professor of Medical Ethics and Legal Medicine Department of Pathology and Legal Medicine. Faculty of Medicine of Ribeirão Preto. University of São Paulo
  • Other Contributors:
    • Marco Aurelio Guimarães, Associate Professor of Legal Medicine
    • Waynice Neiva de Paula Garcia, Assistant Professor of Anesthesiology

  The excellent essay published by Wynne et al (2020) in the journal of Medical Ethics 1 provides a timely reflection on the urgent need for improvements in the “provision of palliative care in humanitarian and emergency contexts” emphasized by the current Covid-19 pandemic. Regarding this issue, we would like to add some reflections from a developing country perspective about the death in abandonment that may support the authors proposal.
  In 1343 Giovanni Boccaccio wrote about the patients with the Bubonic Plague in The Decameron: “Most of them remained in their houses, either through poverty or in hopes of safety, and fell sick by thousands. Since they received no care and attention, almost all of them died”. It is staggering that these words fit to describe the current situation of many patients with severe forms of Covid-19 that do not find places in hospitals. They are being denied even a palliative care and eventually die in their homes or elsewhere in a state of abandonment. This dramatic situation is unprecedented in modern times in wealthy societies. Unfortunately, it is not a novelty in many developing countries that chronically suffer from inadequate health systems, which are now crumbling with the current pandemic. In 1989, Marcio Fabri dos Anjos, a brazilian bioethicist proposed the term mysthanasia (from the Greek: mys = unhappy, thanathos = death) to characterize the death in state of abandonment (Ferreira & Porto, 2019). 2 It was attributed to the h...

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  The excellent essay published by Wynne et al (2020) in the journal of Medical Ethics 1 provides a timely reflection on the urgent need for improvements in the “provision of palliative care in humanitarian and emergency contexts” emphasized by the current Covid-19 pandemic. Regarding this issue, we would like to add some reflections from a developing country perspective about the death in abandonment that may support the authors proposal.
  In 1343 Giovanni Boccaccio wrote about the patients with the Bubonic Plague in The Decameron: “Most of them remained in their houses, either through poverty or in hopes of safety, and fell sick by thousands. Since they received no care and attention, almost all of them died”. It is staggering that these words fit to describe the current situation of many patients with severe forms of Covid-19 that do not find places in hospitals. They are being denied even a palliative care and eventually die in their homes or elsewhere in a state of abandonment. This dramatic situation is unprecedented in modern times in wealthy societies. Unfortunately, it is not a novelty in many developing countries that chronically suffer from inadequate health systems, which are now crumbling with the current pandemic. In 1989, Marcio Fabri dos Anjos, a brazilian bioethicist proposed the term mysthanasia (from the Greek: mys = unhappy, thanathos = death) to characterize the death in state of abandonment (Ferreira & Porto, 2019). 2 It was attributed to the health systems failures due to insufficient funding, corruption and/or poor management. However, even theoretically unexpected, it is also happening in wealthy societies because their health systems became overwhelmed due to the pandemic. Regardless of its cause, misthanasia should not occur in any circumstances. Borasio et al (2020) 3 appropriately mentioned that “It is an ethical imperative to provide high quality palliative care for all patients who are likely to die from COVID-19, especially given their high symptom burden (dyspnea, anxiety etc.).”
  To avoid misthanasia it would initially be necessary to acknowledge its existence and scale. In sequence, the palliative care should be organized for all the patients that need it, even in the eventuality of the local health system being unable to provide the appropriate curative treatment approaches. This is a moral imperative. It is a fundamental medical and humanitarian issue that does not require any major investment. Almost seven centuries after the narrative of the Plague in The Decameron it is embarrassing to acknowledge that humankind remains unable to avoid a pandemic or to provide proper curative treatment for all the patients suffering from it. Nevertheless, more empathy and care towards the ones that are left behind could be shown, because at least this is in our hands.

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  Conflict of Interest:
  None declared.

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