RESUMO
Background: Legal concerns have been implicated in the occurrence of variability in decisions of limitations of medical treatment (LOMT) before death. Objective: We aimed to assess differences in perceptions between physicians and prosecutors toward LOMT. Measurements: We sent a survey to intensivists, oncologists, and prosecutors from Brazil, from February 2018 to May 2018. Respondents rated the degree of agreement with withholding or withdrawal of therapies in four different vignettes portraying a patient with terminal lung cancer. We measured the difference in agreement between respondents. Results: There were 748 respondents, with 522 (69.8%) intensivists, 106 (14.2%) oncologists, and 120 (16%) prosecutors. Most respondents agreed with withhold of chemotherapy (95.2%), withhold of mechanical ventilation (MV) (90.2%), and withdrawal of MV (78.4%), but most (75%) disagreed with withdrawal of MV without surrogate's consent. Prosecutors were less likely than intensivists and oncologists to agree with withhold of chemotherapy (95.7% vs. 99.2% vs. 100%, respectively, p < 0.001) and withhold of MV (82.4% vs. 98.3% vs. 97.9%, respectively, p < 0.001), whereas intensivists were more likely to agree with withdrawal of MV than oncologists (87.1% vs. 76.1%, p = 0.002). Moreover, prosecutors were more likely to agree with withholding of active cancer treatment than with withholding of MV [difference (95% confidence interval, CI) = 13.2% (5.2 to 21.6), p = 0.001], whereas physicians were more likely to agree with withholding than with withdrawal of MV [difference (95% CI) = 10.9% (7.8 to 14), p < 0.001]. Conclusions: This study found differences and agreements in perceptions toward LOMT between prosecutors, intensivists, and oncologists, which may inform the discourse aimed at improving end-of-life decisions.
Assuntos
Advogados/psicologia , Neoplasias Pulmonares/terapia , Oncologistas/psicologia , Assistência Terminal/legislação & jurisprudência , Assistência Terminal/normas , Suspensão de Tratamento/legislação & jurisprudência , Suspensão de Tratamento/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Tomada de Decisão Clínica , Feminino , Humanos , Líbano , Masculino , Pessoa de Meia-Idade , Oncologistas/estatística & dados numéricos , Inquéritos e Questionários , Assistência Terminal/psicologia , Suspensão de Tratamento/estatística & dados numéricosAssuntos
Atitude do Pessoal de Saúde , Assistência Terminal/normas , Adulto , Brasil , Direito Penal/métodos , Direito Penal/tendências , Cuidados Críticos/métodos , Cuidados Críticos/psicologia , Feminino , Humanos , Advogados/psicologia , Masculino , Pessoa de Meia-Idade , Oncologistas/psicologia , Inquéritos e Questionários , Assistência Terminal/métodos , Assistência Terminal/psicologiaRESUMO
Este estudo destaca mudanças ocorridas no Ocidente, inclusive no Brasil, em decorrência da substituição do princípio do paternalismo pelo consentimento livre e esclarecido nas relações biomédicas, com destaque para a integração da autonomia como princípio inerente à dignidade humana. O respeito à autonomia, à autodeterminação pessoal é a base para a suspensão de esforço terapêutico dos usuários dos serviços de saúde com capacidade preservada. Por suspensão de esforço terapêutico compreende-se não iniciar ou suspender terapia iniciada, não ressuscitar nos casos de parada cardiorrespiratória, não submeter o doente à ventilação mecânica, alimentação e hidratação artificiais contra a sua vontade, que pode ser instante ou manifestada em diretivas antecipadas. Os médicos e demais profissionais de saúde têm o dever de respeitar a autonomia do usuário, inclusive para lhe dar alta "a pedido", deixando que a morte ocorra no local, no tempo e em companhia de quem o doente quiser. O usuário dos serviços de saúde tem o direito de estar só e de morrer só, de estar acompanhado e de morrer entre os seus.
Assuntos
Humanos , Autonomia Pessoal , Direito a Morrer/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , BrasilRESUMO
The present study describes the changes that have occurred in most Western countries, Brazil included, since medicine has shifted progressively from a paternalistic model to one that promotes patients autonomy and self-determination. Respect for patient autonomy and self-determination is the primary basis for withholding and withdrawing life support. An adult patient who has decision-making capacity and is appropriately informed has the right to forgo all forms of medical therapy, including life support measures. The right to refuse treatment applies equally to withholding therapy that might be offered, such as cardiopulmonary resuscitation, and to withdrawing therapy that is already underway, such as artificial hydration, nutrition, and ventilation. This right is based on the ethical principle of autonomy or self-determination. Helping an informed and capable patient to forgo life support under these circumstances is regarded as distinct from participating in requested homicide, assisted suicide, or passive/active euthanasia. The patient has the right to choose, including where the deathbed will be placed, and to be left alone with family at that time.