Medical ethical decision in the care of terminal patients

Authors

  • Nancy Mineko Koseki Divisão de Oncologia. Centro de Atenção Integral à Saúde da Mulher. Faculdade de Ciências Médicas. Universidade Estadual de Campinas (CAISM-UNICAMP), Campinas (SP), Brasil
  • Eduardo Bruera Director, Palliative Care Program. Edmonton General Hospital and Coordinator, W.H.O. Cancer Pain and Palliative Care Program, Care Program for Latin America.

DOI:

https://doi.org/10.32635/2176-9745.RBC.1996v42n1.2871

Keywords:

Ethical Decision, Health Professionals, Terminally Ill Patients

Abstract

Health professionals who take care of terminally ill patients are many times faced to the dilemma of deciding which is the best therapeutic approach for these patients, or when starting or withholding or withdrawing a certain treatment. Many decisions may interfere directly or indirectly on the death process, even antecipating it, eventhough this isn’t the primary intention. In this issue, we make a brief revision about the basic ethical principies that guide the decision process, which many result in two wide lines of treatment. We present some cases as examples to discuss these ethical and theological considerations.

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References

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

Published

2022-10-04

How to Cite

1.
Koseki NM, Bruera E. Medical ethical decision in the care of terminal patients. Rev. Bras. Cancerol. [Internet]. 2022 Oct. 4 [cited 2024 Nov. 22];42(1):15-29. Available from: https://rbc.inca.gov.br/index.php/revista/article/view/2871

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Section

ORIGINAL ARTICLE