Percepção de enfermeiras intensivistas de hospital regional sobre distanásia, eutanásia e ortotanásia. Article (PDF Available) · December with 32 Reads. Nenhum enfermeiro soube conceituar eutanásia, metade conceituou distanásia e apenas um terço a ortotanásia. Do total, 65,39% reconhecem algum desses. Eutanasia e distanasia. In Costa, S. I. F., G. Oselka and V. Bottle, eds., Iniciacao a Bioetica. Brasilia: Conselho Federal de Medicina, pp. Mello, A. G.
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Ethical issues surrounding brain death and end-of-life have not been afforded in Brazil the same attention as in many developed countries. There appears to be reluctance on the part of Brazilian doctors to limit or suspend procedures or treatment which prolongs life of patients in terminal phases of severe incurable illness, or to suspend the artificial means of supporting vegetative functions in cases of brain death outside the context of organ and tissue donation for transplant.
Fears grounded in possible administrative Regional Medical Councils or legal repercussions, as well as ambiguous interpretations of religious precepts, partially explain this reluctance which often results in unnecessary prolonging of patient suffering. A recent resolution by the Federal Medical Council on end-of-life may offer doctors some guidance and confidence in dealing with highly complex ethical situations.
Any discussion on brain death must take into account the first Brazilian law on transplants which clearly stated that the criteria for defining brain death were to be determined by the Federal Medical Council FMC. This law was promulgated in February and states that removal post mortemof tissues, organs or parts of the human body destined for transplant or treatment must be preceded by diagnosed brain death, according to the clinical and technological criteria set forth by resolution of the Federal Medical Council.
The FMC enacted a Resolution in which, upon establishing the criteria for brain death took into consideration that:.
Ethical aspects of brain death and end-of-life
This resolution set forth that: The Resolution also stipulates that brain death must have resulted from an irreversible process and a known cause, and that the clinical parameters to be observed in ascertaining brain death are: Enactment of this resolution created a rare situation in Brazil whereby a clear definition by the organ responsible for medical ethics on what constitutes brain death exists in parallel with a legal position establishing brain death to be that determined by the FMC.
This is an exceptional situation amidst the numerous ethical dilemmas in our milieu.
For example, assisted reproduction also has a normative resolution by the FMC, but ethical debates on the issue remain extremely heated, yet no laws provide for norms governing procedures related to assisted reproduction. Likewise, issues surrounding end-of-life have no specific legislation, and as will become apparent, the ethical discussion on this matter is also heated.
Despite the evident ethical and legal agreement regarding brain death, in practice these cases continue to be a source of doubt and controversy in Brazil.
In the context of organ donation for organ and tissue transplant this presents no futanasia obstacle: However, when brain death is ascertained outside the organ donation context, the situation is radically different. In such cases, ascertainment of brain death is often not followed by suspension of ventilation support and other life-prolonging measures. For instance, a recent study 3 within Pediatric Intensive Care Units PICUs revealed that the time period for withdrawal of vital support following brain death was 1.
Thus there seems to be a curious dichotomy among Brazilian doctors, with clear acceptance of the criteria in cases of organ donation for organ transplants, yet reluctance to accept them in other situations. This scenario, which is definitely not restricted to only pediatric PICUs, is cause for concern, and the FMC is working on the enactment of a normative resolution which will contribute toward definitively clarifying that criteria for brain death are valid in all situations, not being dependent on possible organ and tissue donation.
Another situation linked to end-of-life raises even more complex questions. There are a vast number of patients, both children and adults, hospitalized in infirmaries or intensive care units, in a terminal phase of severe and incurable illness, who are being given life-prolonging treatment, without these individuals having been given the option to limit this type of treatment.
This situation is not peculiar to Brazil, it does however appear to be more common among us than in many developed countries. The answer is not straightforward. Certainly, there are a series of contributing factors, but three seem to be fundamental; fear of judicial repercussions, fear of administrative consequences in the Medical Council ambit, and religious beliefs.
We shall examine each briefly. Many doctors believe that the Medical Ethics Code 9 takes an opposing stance to any manner of restricting treatment to terminal patients.
Having participated directly in the process of drafting this Code ofone of the authors GO assures that the emphasis of this article is the use of available treatment to benefit the patientwhich in turn does not imply always using all treatments available. The key point is to assess — and this is a joint decision between the doctor and the patients or those representing them — over whether a given intervention prolonging life in that case will benefit the patient. Clearly, however, the manner in which the article is worded leads to ambiguous interpretation.
For this reason, a recent FMC resolution on end-of-life is so crucial. There are also other important aspects addressed in the resolution. Fear of legal repercussions of suspending or limiting treatment is a more complex discussion. Unfortunately, in contrast to what has been the case in developed countries for decades, Brazil has no clear jurisprudence on this matter, leaving this open to different interpretations.
Orthothanasia | definition of orthothanasia by Medical dictionary
There are a number of respected attorneys and jurists who defend the notion that any suspension or limitation of treatment, even in patients clearly incapable of recovering, constitutes dereliction of medical duty, with all the legal consequences this implies.
This is apparently the perception of a large proportion of Brazilian doctors. Again, to date there have been no cases in common courts of a doctor being denounced, sued or sentenced for this reason.
Occasionally there are objections to limiting treatment in terminal patients for religious reasons. This is particularly true in Brazil with regard to the position of the Catholic Church, recognized as an intransigent advocate of the sacredness of life. Doctors and patients often believe the Catholic Church would never accept any manner of treatment limitation, on the understanding that this is a Divine prerogative.
In one of his encyclicals, John Paul II, lucidly and in-depth, clarifies the position with which many patients and doctors certainly agree: Attempting to understand the factors behind doctors not offering patients in terminal phases of severe and incurable sickness the options the doctors deem best, constitutes part of the absolutely indispensable process of involving not only doctors and other health professionals, but also society as a whole, in discussing a situation which is currently clearly not working in the best interests of our patients.
National Center for Biotechnology InformationU. Journal List Dement Neuropsychol v. Gabriel Oselka 1 and Reinaldo Ayer de Oliveira 2. Find articles by Gabriel Oselka. Find articles eutanasiz Reinaldo Ayer de Oliveira. Author information Copyright and License information Disclaimer.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, distsnasia reproduction in any medium, provided the original work is properly cited. Abstract Ethical issues surrounding brain death and end-of-life have not been afforded in Brazil the same attention as in many developed countries.
The FMC enacted a Resolution in which, upon establishing the criteria for brain death took into consideration that: Total and irreversible arrest of brain functions are equivalent to death, according to well established criteria by the global scientific community.
There is a psychological and material burden distansaia by prolonging the use of extraordinary resources to support vegetative functions in patients with total and irreversible arrest of brain activity.
J Ped Rio J ; Silva Nei Moreira da.
Moritz RD, Pamplona F. Rev Bras Terap Inten. End-of-life care in the intensive care unit state of art in Conselho Federal de Medicina. Support Center Support Center.