RESUMO.Este artigo se propõe a discutir as dimensões emocionais e éticas envolvidas no cuidado do médico com o paciente em situação de terminalidade em UTI. Realizou -se uma pesquisa qualitativa, na qual foram entrevistados seis membros da equipe médica intensivist a de um hospital privado de médio porte. Da análise do conteúdo das entrevistas, emergiram seis categorias temáticas: percepção sobre o paciente em situação de terminalidade; emoções frente à morte e ao morrer; conflitos éticos; família diante da terminalidade; comunicando más notícias e relação médico-família no processo de tomada de decisões. Neste trabalho, são apresentadas as três primeiras categorias. Os resultados apontaram que a morte e o morrer são fenômenos que causam estranheza ao médico intensivi sta, pois este espera conseguir salvar a vida do paciente e conta com equipamentos de suporte avançado de vida. A complexidade envolvida na definição da terminalidade, aliada ao avanço das técnicas da medicina como ventilação mecânica, hemodiálise, nutriçã o enteral e parenteral, entre outras, podem favorecer a promoção da distanásia em UTI, constituindo um cenário propício para o surgimento de conflitos entre a família e a equipe médica. Palavras-chave: Pacientes terminais; unidades de terapia intensiva; médicos. TERMINALITY IN THE ICU: THE EMOTIONAL AND ETHICAL DIMENSIONS OF THE MEDICAL CARE OF THE INTENSIVISTABSTRACT. The purpose of this article is to discuss the emotional and ethical dimensions involved in the medical care for terminally ill patients held in Intensive Care Unit (ICU). We conducted a qualitative research in which we interviewed six members of the intensivist medical staff of a medium -sized private hospital. Six theme categories emerged from the content analysis: perception of the patient in terminal condition; emotions towards death and dying; ethical conflicts; family facing terminality; communicating bad news; and the doctor-family relation in the decision making process. In this study we will present the first three categories. The results showed that death and dying are phenomena that cause uneasiness in the intensivist doctor, since he/she expects to save the life of the patient and counts with the help of advanced life support equipment. The complexity involved in the definition of t erminality, combined with advances in medical techniques -such as mechanical ventilation, hemodialysis, enteral or parenteral nutrition, among others -may favor the promotion of dysthanasia in ICU, establishing a suitable scenario for the emergence of conflicts between the family and medical staff.

ResumoO presente estudo é parte de investigação mais ampla sobre as repercussões da terminalidade para os familiares de pacientes gravemente enfermos em Unidade de Terapia Intensiva (UTI). Utilizou-se metodologia clínico-qualitativa de pesquisa. Foram entrevistados seis familiares de pacientes em situação de terminalidade em UTI de um hospital privado de médio porte. Da análise do conteúdo das entrevistas, emergiram cinco categorias: percepção sobre a doença e a evolução clínica; impacto da internação em terapia intensiva; percepções s obre a terminalidade; processo de tomada de decisão; e relação com a equipe médica. Neste trabalho, serão apresentadas as três primeiras categorias, com o objetivo especí-fi co de discutir percepções e recursos emocionais dos familiares diante da terminalidade. Constatou-se que a morte iminente do paciente promove grande angústia e sofrimento para os familiares, provocando intensas vivências de desamparo. O luto antecipatório foi um recurso adaptativo utilizado pelos membros da família, permitindo assim que reorganizassem seus recursos. Foi evidenciado também um comportamento resiliente entre os familiares, facilitado pelo suporte social e familiar, pela qualidade do vínculo familiar-paciente, pela percepção de que o doente não está sofrendo e pela presença da religião ou da espiritualidade. Palavras-chave:Unidade de terapia intensiva, família, terminalidade. Death on Stage in the ICU: Family Facing Terminal Condition AbstractThe present study is part of a broader investigation with the purpose of investigating the repercussions of terminal conditions on the families of gravely ill patients hospitalized in Intensive Care Units (ICUs). The study used a qualitative clinical research methodology. Six family members of terminal patients admitted to the ICU of a medium-sized private hospital were interviewed. Five categories emerged from the analysis of the content of the interviews: perception of the illness and clinical progress; impact of admission to intensive care units; perception of the terminal condition; decision-making process; and relationship with the medical staff. This paper will present the fi rst three categories, aiming to discuss the family members' perceptions and their emotional resources in the face of a terminal condition. Evidence shows that the imminent death of the patient generates great distress and suffering for relatives, causing intense experiences of helplessness. Family members used anticipatory mourning as a coping mechanism, allowing them to reassess their resources. Relatives also demonstrated resilient 1

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The objective of this research is to investigate family members’ perceptions as to the end-of-life decision-making process in an ICU. The authors conducted a qualitative descriptive study in which they interviewed six family members of critically ill patients admitted to the ICU of a private hospital. Five categories of analysis emerged from the examination of the material. This study will discuss two of those categories: the decision-making process and the relationship with the medical staff. The results indicate that family members were satisfied with communication with the medical staff, an important aspect for the decision-making process. Within this context, the shared model, prioritization of palliative care and identification of futile treatments prevailed, aimed at ensuring the patient’s comfort and dignity at the end of life. The results also reveal the need for integration of palliative care in ICUs, particularly in end-of-life situations.

The aim of this study was to look into the repercussions of childbirth care models on the experiences of fathers and mothers. A qualitative research investigation was carried out through a collective case study, in which 30 birth reports published on personal blogs dealing with pregnancy, childbirth and parenthood experiences were analyzed, 15 written by women and 15 by men. The results pointed to the helplessness felt by fathers and mothers in the face of technocratic assistance and to the idealization of childbirth care offered by health professionals who work according to the humanized model. The idea of ​​choosing the mode of delivery appeared frequently in the reports, pointing to a scenario in which caesarean section is understood as a consumer good. It was concluded that care, support and respect for the parturient should be promoted by health professionals as fundamental requirements for childbirth care.