Decisão médica ética em casos de pacientes terminais
DOI:
https://doi.org/10.32635/2176-9745.RBC.1996v42n1.2871Palavras-chave:
Decisão Ética, Profissionais da Saúde, Pacientes TerminaisResumo
Os profissionais da saúde que cuidam de doentes terminais muitas vezes enfrentam a angústia, o dilema de decidir qual a melhor conduta para estes pacientes, quando iniciar, manter ou suspender um determinado tratamento. Muitas decisões interferem direta ou indiretamente no processo de morte, podendo antecipá-la, apesar de não ser esta a intenção primária. Neste artigo, fazemos uma breve revisão sobre os princípios éticos básicos que direcionam o processo de “decisão” que pode resultar em dois amplos caminhos de ação em relação ao tratamento. Apresentamos alguns casos como ilustração para discutir estas considerações éticas e teológicas.
Downloads
Referências
Guidelines on the termination of life sustaining treatment and the care of the dying. Um relatório realizado por The Hastings Center. Briarcliff Manor, New York, 1987.
Roy, D.J. - Ethical issues in the treatment of cancer patients. J Pall Care, 5(2): 56-61, 1989. DOI: https://doi.org/10.1177/082585978900500217
Casswell, D.G - Rejecting criminal liability for life-shortening palliative care. J Pall Care, 6(2): 15-23, 1990. DOI: https://doi.org/10.1177/082585979000600204
Davidson, B.; Laan, R.V.; Davis, A. et al. - Ethical reasoning associates with the feeding of terminally ill elderly cancer patients. Cancer Nursing, 13(5): 286- 292, 1990 DOI: https://doi.org/10.1097/00002820-199010000-00003
Eisendrath, S. J.; Jonsen, A.R. - The living will. Help or hindrance? JAMA, 249(15): 2054-2058, 1983. DOI: https://doi.org/10.1001/jama.249.15.2054
Kelner, M.J.; Bourgeault, I.L. – Patient control over dying; responses of health care professionals. Soc Sci Med, 36(6): 757-765, 1993. DOI: https://doi.org/10.1016/0277-9536(93)90036-4
Fraser, R. - Advance treatment directives clearly communicating patients’ choices. Bioethics Bulletin, 3(2): 1-2, 1991.
Mount, B.M.; Hamilton, P. – When palliative care fails to control suffering. J Pall Care, 10(2): 24-26, 1994. DOI: https://doi.org/10.1177/082585979401000205
Waithe, M.E.; Ozar, D.T. - The ethics of teaching ethics. Hastings Center Report, 20(4): 17-21, 1990. DOI: https://doi.org/10.2307/3562761
Kryspin, J.; Phyllips, H. - Beyond Beneficence: an ethical perspective on terminal care. Humane Medicine, 3(2): 82-92, 1987.
Latimer, E.J. - Ethical decision-making in the care of the dying and its applications to clinicai practice. J Pain Symptom Manage, 6(5): 329-336, 1991. DOI: https://doi.org/10.1016/0885-3924(91)90058-C
Byock, I.R. - Consciously walking the fine line: thoughts on a hospice response to assisted suicide and euthanasia. J Pall Care, 9(3): 25-28, 1993.
Dickens, B.M. - When terminally ill patients request death: assisted suicide before Canadian Courts. J Pall Care, 10(2); 52-56, 1994. DOI: https://doi.org/10.1177/082585979401000210
Foley, K.M. - The relationship of pain and symptom management to the patient requests for physician-assited suicide. J Pain Symptom Manage, 6(5): 289-297, 1991. DOI: https://doi.org/10.1016/0885-3924(91)90052-6
Fried, T.R.; Stein, M.D.; O’Sullivan, P.S.; Brock, D.W,; Novack, D.H. – Limits of patient autonomy. Physician atitudes and practices regarding life-sustaining treatments and euthanasia. Arch Intern Med, 153: 722-728, 1993. DOI: https://doi.org/10.1001/archinte.153.6.722
Miller, F.G.; Quill, T.E.; Brody, H.; Fletcher, J.C.; Gostin, L.O.; Meier, D.E. - Regulating physician-assisted death. N Engl J Med, 331(2): 119-123, 1994. DOI: https://doi.org/10.1056/NEJM199407143310211
Bole III, T.J. The rhetoric of rights and justice in health care. In: Bole, T.J. & Bondenson, W.B. (eds.): Rights to Health Care. Dordrecht, Boston, Kluwer Academic, 1991, pp. 1-19. DOI: https://doi.org/10.1007/978-0-585-28295-4_1
Gillon, R. - mgths.BrMedJ, 290: 1890- 1891, 1985. DOI: https://doi.org/10.1136/bmj.290.6485.1890
Guidelines for bioethical decision making in nursing. Publicado pela Alberta Association of Registered Nurses (AARN), Edmonton, Alberta, Canadá, 1987.
Luce, J.M. - Ethical principies in critical care. JAMA, 263(5): 696-700, 1990. DOI: https://doi.org/10.1001/jama.263.5.696
Raffin, T.A. - Withholding and withdrawing life support. Hospital Practice, 26(3): 133-155, 1991. DOI: https://doi.org/10.1080/21548331.1991.11707718
Skelton, D. - Health Care. The hospice movement: a humam approach to palliative care. Can Med Assoe J, 126: 556-558, 1982.
Wilson, D. - New insigths into the old controversy over long-term tube feeding. The Bioethics Bulletin, 5(2): 1-3, 1993.
Bergan, R. - Ethics concepts and practice. International Nursing Review, 20(5): 140, 1973.
Parsons, P.H. - Approaches to decision making in ethics. In: Parsons, A.H. & Parsons, P.H. (eds.): Health Care Ethics. Toronto, Ontario & Middletown, Ohio, Wall & Emerson, Inc, 1992, pp. 11-16.
Lynõe, N. - Ethical and professional aspects of the practice of alternative medicine. Scand J Soc Med, 20(4):2n-225, 1992. DOI: https://doi.org/10.1177/140349489202000406
Gillon, R. Paternalism and medical ethics. Br Med J, 290: 1971-1972,1985. DOI: https://doi.org/10.1136/bmj.290.6486.1971
Burrows, J.H.; Coloney, M.; Fisher, M.; Reilly, L.T.; 0’Shaughnessy, A. – Pain management. Theological and ethical principies governing the use of pain relief for dying patients. Helath Progress, 74 (1): 30-39, 1993.
Rodney, P. - A nursing perspective of life-prolonging treatment. J. Pall Care, 10(2): 40-44, 1994. DOI: https://doi.org/10.1177/082585979401000208
Dossetor, J.B. -Withdrawal of treatment: is it ever justifiable? Humane Medicine, 7(3): 217-221, 1991.
Eys, J.V. - The ethics of palliative care. J Pall Care, 7(3): 27-32, 1991. DOI: https://doi.org/10.1177/082585979100700306
Latimer, E. - Ethical challenges in câncer care. J Pall Care, 8(1): 65-70, 1992. DOI: https://doi.org/10.1177/082585979200800114
Steinberg, M.I. - The Califórnia natural death act - a failure to provide for adequate patient safe guards and individual autonomy. Connecticut Law Review, 9(2): 203-226, 1977.
Gillon, R. - Autonomy and the principie of respect for autonomy. Br Med J, 290: 1806-1808, 1985. DOI: https://doi.org/10.1136/bmj.290.6484.1806
Dossetor, J.B. - The faces of autonomy. Editor’s forum. The Bioethics Bulletin, 5(2): 7, 1993.
Ott, B.B.; Niewiadomy, R.M. – Support of patient autonomy in the do not resuscite decision. Heart Lung, 20(1): 66-74, 1991.
Steinbrook, R.; Lo, B. - Decision making for incompetent patients bytt designated proxy. Califórnia’s New Law. N Engl J Med, 310(24): 1598-1601, 1984. DOI: https://doi.org/10.1056/NEJM198406143102411
Suber, D.G.; Tabor, W.J. – Withholding of life-sustaining treatment from the terminally ill incompetent patient: who decides? JAMA, 248(18): 2250-2251, 1982. DOI: https://doi.org/10.1001/jama.248.18.2250
Wanzer , S.H.; Adelstein, J.; Cranford, R.E. et al. - The physician’s responsability toward hospelessly ill patients. N Engl J Med, 310(15): 955-959, 1984. DOI: https://doi.org/10.1056/NEJM198404123101505
Gillon, R. - Beneficence: doing good for others. Br Med J, 291: 44-45, 1985. DOI: https://doi.org/10.1136/bmj.291.6487.44
Gillon, R. - “Primum non nocere” and the principie of non-maleficence. Br Med J, 291: 130-131, 1985. DOI: https://doi.org/10.1136/bmj.291.6488.130
Gillon, R.- Justice and medical ethics. Br Med J, 291: 201-202, 1985. DOI: https://doi.org/10.1136/bmj.291.6489.201
Bayer, R.; Callahan, D.; Fletcher, J. et al. - The care of the terminally ill: mortality and economics. N Engl J Med, 309(24): 1490-1494, 1983. DOI: https://doi.org/10.1056/NEJM198312153092405
Hammes, tion, 5: 51-57, 1987. B.J.; Cain, J.M. - The ethics of pain management for cancer patients; case studies and analysis. J Pain Symptom Manage, 9(3): 166-170, 1994. DOI: https://doi.org/10.1016/0885-3924(94)90126-0
Care of the dying: a catholie perspective. Part III: clinical context - good palliative care eases the dying process. Publicado pela Catholic Health Association. Health Progress, 74(4): 22-31, 1993.
Giesen, D.; Hayes, J. - The patient’s rigth to know. A comparative view. Anglo-American Law Review, 21(2): 101-122, 1992.
Meyers, C. - The impact of physician denial upon patient autonomy and well-heing. J Med Ethics, 18: 135-137, 1992. DOI: https://doi.org/10.1136/jme.18.3.135
Vila-Vicencio, C. - On telling the truth. Medical patternalism, patient autonomy and counsellor mediation. S A Journal Continuing Continuing Medical Education, 5: 51-57, 1987.
Bates, T.; Connor, C.; Connor, S. et al. - A statement of assumptions and principies concerning psychological care of dying persons and their families. J Pall Care, 9(3): 29-32, 1993.
Latimer, E.J.; Dawson, H.R. – Palliative care: principies and practice. Can Med Assoc J. 148(6): 993-994, 1983.
Roy, D.J. - Those days arelong gone now. J Pall Care, 10(2): 4-6, 1994. DOI: https://doi.org/10.1177/082585979401000201
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
