scholarly journals Distanásia: o tratamento médico fútil e/ou inútil. Da angústia à serenidade do equacionamento bioético

2018 ◽  
Vol 75 (300) ◽  
pp. 776
Author(s):  
William Saad Hossne ◽  
Leo Pessini
Keyword(s):  
End Of Life Care ◽  
Scientific Literature ◽  
Medical Liability ◽  
Life Care ◽  
Futile Treatment ◽  
The Face ◽  
Bioethical Issues ◽  
Definition Of ◽  
Semantic Definition

Síntese: O prolongamento sofrido do processo do morrer, que mais acrescenta sofrimento e prorroga morte, é uma das questões bioéticas mais complexas e debatidas hoje, no contexto de cuidados de final de vida. A complexidade inicia-se na própria definição semântica desta problemática bioética. Nossa busca é marcada pela “angústia criativa” (não a patológica que nos paralisa frente à vida) que busca identificar vários termos e neologismos para nomear e definir a questão bioética: distanásia, medicina/e/ou tratamento fútil e inútil, e para definir aquela ação diagnóstica e terapêutica médica que já não mais beneficia o paciente em sua fase final de vida. Para o equacionamento da problemática bioética buscamos luzes na literatura científica médica e bioética internacional, bem como na tradição da ética médica brasileira, em sua versão codificada. Embora um determinado tratamento possa ser fútil e, portanto, inútil, o cuidado nunca será fútil e inútil. No coração de toda ação de cuidar deve estar presente a “philia” (amor, amizade). Podemos, sim, ser curados de uma doença mortal, mas não de nossa mortalidade e finitude. Nossa condição de existir não é uma patologia. Quando esquecemos isto, caímos na tecnolatria, e os instrumentos de cura e cuidado facilmente se transformam em ferramentas de tortura. O presente artigo procura apresentar uma metodologia de como lidar com estas situações eticamente conflitivas, ao aprofundar alguns conceitos éticos fundamentais, tais como: processo de deliberação, decisão e responsabilidade médica e o papel de comissões de bioética. A busca do adequado equacionamento ajuda-os na trajetória que vai da angústia à serenidade.Palavras-chave: Bioética. Distanásia. Tratamento fútil. Cuidado. Philia.Abstract: The painful extension of the dying process, which brings more suffering and delays death, is one of the most complex bioethical issues discussed today in the context of end of life care. The complexity begins in the very semantic definition of this bioethical problem. Our quest is marked by a “creative anguish” (not by the pathological one that paralyzes us in the face of life) that seeks to identify various terms and neologisms, in order to give a name to and define the bioethical issue: dysthanasia, futile and useless medicine and/or treatment; and also in order to define that diagnostic action and medical therapy that no longer benefits the patient in his/her final stage of life. For the equating of this bioethical problem, we look for some light in the medical scientific literature and in international bioethics, as well as in the tradition of the brazilian medical ethics in its codified version. Although a particular treatment can be futile and therefore useless, care will never be futile and useless. At the heart of every act of caring “philia” (love, friendship) must be present. Yes, we may be cured of a deadly disease, but not of our mortality and finitude. The condition of existing is not a pathology. When we forget this, we fall into the technolatry, and the instruments of healing and care easily turn into instruments of torture. This article attempts to present a methodology for dealing with these ethically conflictive situations, as it deals with some basic ethical concepts such as deliberation, decision and medical liability and the role of bioethical committees. The search for the appropriate equation helps us in the path that goes from anguish to serenity.Keywords: Bioethics. Dysthanasia. Futile treatment. Care. Philia.

End of life care in the community: the role of ambulance clinicians

2013 ◽  
Vol 5 (7) ◽  
pp. 394-399 ◽  
Author(s):  
Annie Pettifer ◽  
Rosanna Bronnert
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care

scholarly journals Continuation of end-of-life care in a special elderly nursing home and the role of doctors

2012 ◽  
Vol 49 (3) ◽  
pp. 336-343
Author(s):  
Akira Kurita ◽  
Naosuke Shinagawa ◽  
Eitarou Kodani ◽  
Shinichirou Iwahara ◽  
Bonpei Takase ◽  
...  
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care

Managing End-of-Life Care

2012 ◽  
Author(s):  
John W. Albarran ◽  
Marika Hills
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Care Delivery ◽  
Symptom Relief ◽  
Death And Dying ◽  
Past Century ◽  
Life Care ◽  
Care Needs ◽  
Definition Of ◽  
The Uk

This chapter addresses the fundamental nursing role of managing end-of-life care. Death is as fundamental a part of life as living, and while caring for a dying patient and their family is demanding, complex, and emotionally exhausting, it can also be a gratifying and privileged experience for nurses. Specifically, nurses have a centre-stage role in leading and informing care delivery at the end of life. Care will typically embrace assessing the needs of the patient and family, providing symptom relief and comfort care, and providing cultural and spiritual support. Additionally, caring functions should also extend following death to caring for the deceased in a dignified manner and supporting the newly bereaved, demonstrating genuine concern, compassion, and effective communication skills (Hills and Albarran, 2010a; Maben et al., 2010). To examine the key themes and challenges of practice, it is important to understand the political, professional and societal influences, and contextual nature of death and dying in the UK. At present, there is neither a clear nor universally accepted definition of end-of-life care, but it is generally understood to be the care of a person who is identified as having failing health and who is in a progressive state of decline (Shipman et al., 2008). Establishing the last phase of a patient’s life can be a difficult and complex process, and this might occur:…● after the diagnosis of a life-limiting condition; ● during the transition or deterioration of a chronic disease illness; ● when there is an increasing frailty combined with greater dependence on care provision, particularly in the older adult; ● following a sudden infective episode, cardiac event, or a life-threatening accident….The last phase of end-of-life care is referred to as the dying phase. Consideration of the end-of-life care needs of people with chronic terminal conditions should begin at diagnosis, and must embrace after-death care and family support. Over the past century, progress and advancement in disease management, together with improvements in living standards, have resulted in changes to the national death profile, with currently two-thirds of the 0.5 million annual deaths in the UK occurring in people over 75 years of age.

False Expectations? Expectations vs. Probabilities for Dying

2000 ◽  
Vol 41 (3) ◽  
pp. 157-185 ◽  
Author(s):  
Carolyn M. Smith
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Living Will ◽  
Ethnographic Study ◽  
Life Care ◽  
Patient Attitudes ◽  
Affected Patient ◽  
Catastrophic Illness ◽  
Physician Relationship

It is widely recognized that the role of the physician has undergone dramatic changes in the last century—changes which have serious implications for the patient-physician relationship. This is an ethnographic study examining how certain changes in the role and abilities of biomedical physicians have affected patient attitudes and expectations about end-of-life care. In-home interviews were conducted with eighteen persons age fifty-five and older, including a sample of Hemlock Society members. Results indicate a broad spectrum of end-of-life concerns including capacity, autonomy, pain, and burden to loved ones. Most participants reported a reluctance to begin a discussion of death or future deteriorating capacity with their physicians. Instead, when conversations about death were reported, they had been largely limited to the scenarios of catastrophic illness (e.g., hospitalization, ventilator, etc.) and the Living Will. While this discussion does not overlook the utility of the Living Will, it proposes that reliance on this document for preparing patients for end-of-life care is inadequate.

Defining end-of-life care from perspectives of nursing ethics

2012 ◽  
Vol 19 (5) ◽  
pp. 608-618 ◽  
Author(s):  
Shigeko (Seiko) Izumi ◽  
Hiroko Nagae ◽  
Chihoko Sakurai ◽  
Emiko Imamura
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Hospice Care ◽  
Medical Model ◽  
Codes Of Ethics ◽  
Nursing Ethics ◽  
Life Care ◽  
Care Providers ◽  
Definition Of

Despite increasing interests and urgent needs for quality end-of-life care, there is no exact definition of what is the interval referred to as end of life or what end-of-life care is. The purpose of this article is to report our examination of terms related to end-of-life care and define end-of-life care from nursing ethics perspectives. Current terms related to end-of-life care, such as terminal care, hospice care, and palliative care, are based on a medical model and are restrictive in terms of diagnosis and prognosis. Using codes of ethics for nurses as a framework, we attempt to identify people to whom nurses are responsible to provide end-of-life care and develop a definition of end-of-life care that is more inclusive and applicable to a broader range of people who would benefit from end-of-life care by nurses and other health-care providers.

Ethnic and cultural aspects of palliative care

2015 ◽  
Author(s):  
LaVera Crawley ◽  
Jonathan Koffman
Keyword(s):  
Palliative Care ◽  
End Of Life Care ◽  
World Health ◽  
Life Care ◽  
Cultural Aspects ◽  
Physical Conditions ◽  
Appropriate Treatment ◽  
Definition Of ◽  
Health Organization

This chapter attempts to identify ‘differences that make a difference’ when individuals and groups negotiate institutions and practices for palliative and end-of-life care. Two influences on the practice of palliative care-immigration and health disparities-are examined. The World Health Organization definition of palliative care specifies two goals: improving quality of life of patients and families and preventing and relieving suffering. It identifies three ‘colour blind’ strategies for meeting those goals: early identification, impeccable assessment, and (appropriate) treatment. Lastly, the definition addresses four domains of care: (1) problems related to pain, (2) physical conditions, (3) the psychosocial, (4) and the spiritual. This chapter specifically addresses these goals, strategies, and domains in relation to delivering quality palliative care in cross- or multicultural settings.

scholarly journals P142: Gaps in public preparedness to be a substitute decision maker and the acceptability of high school education on resuscitation and end-of-life care: a mixed-methods study

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S115-S116
Author(s):  
M. Wong ◽  
M. Medor ◽  
K. Yelle Labre ◽  
M. Jiang ◽  
J. Frank ◽  
...  
Keyword(s):  
High School ◽  
Mixed Methods ◽  
Critical Illness ◽  
End Of Life ◽  
Decision Maker ◽  
End Of Life Care ◽  
High School Education ◽  
Life Care ◽  
Substitute Decision Maker

Introduction: When a patient is incapable of making medical decisions for themselves, choices are made according to the patient's previously expressed, wishes, values, and beliefs by a substitute decision maker (SDM). While interventions to engage patients in their own advance care planning exist, little is known about public readiness to act as a SDM on behalf of a loved one. This mixed-methods survey aimed to describe attitudes, enablers and barriers to preparedness to act as a SDM, and support for a population-level curriculum on the role of an SDM in end-of-life and resuscitative care. Methods: From November 2017 to June 2018, a mixed-methods street intercept survey was conducted in Ottawa, Canada. Descriptive statistics and logistic regression analysis were used to assess predictors of preparedness to be a SDM and understand support for a high school curriculum. Responses to open-ended questions were analyzed using inductive thematic analysis. Results: The 430 respondents were mostly female (56.5%) with an average age of 33.9. Although 73.0% of respondents felt prepared to be a SDM, 41.0% of those who reported preparedness never had a meaningful conversation with loved ones about their wishes in critical illness. The only predictors of SDM preparedness were the belief that one would be a future SDM (OR 2.36 95% CI 1.34-4.17), and age 50-64 compared to age 16-17 (OR 7.46 95% CI 1.25-44.51). Thematic enablers of preparedness included an understanding of a patient's wishes, the role of the SDM and strong familial relationships. Barriers included cultural norms, family conflict, and a need for time for high stakes decisions. Most respondents (71.9%) believed that 16 year olds should learn about SDMs. They noted age appropriateness, potential developmental and societal benefit, and improved decision making, while cautioning the need for a nuanced approach respectful of different maturity levels, cultures and individual experiences. Conclusion: This study reveals a concerning gap between perceived preparedness and actions taken in preparation to be an SDM for loved ones suffering critical illness. The results also highlight the potential role for high school education to address this gap. Future studies should further explore the themes identified to inform development of resources and curricula for improved health literacy in resuscitation and end-of-life care.

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