I read very carefully the publication by Nieto-González et al.1 in Reumatología Clínica, where they present their experience of teleconsultation in paediatric rheumatology during COVID-19. I would like to express my opinion from an ethical perspective.
The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a major health, social, and economic crisis worldwide.2 In a complex situation involving an extreme need for rationality and common sense, the concept of ethical distress regarding the values of healthcare professionals, a group clearly under great strain and at high risk of exposure and contagion, has re-emerged. Ethical distress is defined as the feeling of professional anguish at not being able to carry out their work with the minimum standards of quality care, caused by a lack of sufficient resources, among other factors. It has resulted in emotional exhaustion, moral suffering, accumulated fatigue, and burnout, but also in good practices of change, resilience, and transformation. This last point is of positive note and is where the teleconsultation initiative experienced by the authors in the context of ethical distress comes into play.
It is also just as important to emphasise that the ethics of corporate values of organisations and the system have been affected by public health (a higher good) in terms of: universality, justice, autonomy, intimacy, privacy, confidentiality, humanisation, communication, etc.3 In this sense, the pandemic has revealed some shortcomings, prompting new projects to respond to arising needs: adaptation of the organisation, adaptation of care and non-care processes and spaces, and good practices in the relationship with patients and relatives, along with coordination with other levels of care. This solution presented by the authors during the COVID-19 pandemic has also been reinvented from a corporate and organisational perspective.
Finally, I would suggest that we must rethink the future and recover lost gratitude and self-esteem (as a society and as health professionals), after a pandemic that has been a call for attention and action, to put everything back on track. It is an occasion for examination, learning, and improvement where we can relate to Japanese culture in the concepts of repair (kintsugi), reordering (nankurunaisa), and harmony (feng shui), and take up new challenges in person-centred care.
