Diretivas antecipadas de vontade: benefícios, obstáculos e limites

Abstract

Resumo Resumen Directivas anticipadas de voluntad: beneficios, obstáculos y limitacionesEl concepto de directivas anticipadas de voluntad surgió en respuesta al avance tecnológico y al tratamiento médico agresivo, utilizándoselo en situaciones ambiguas, como ante un pronóstico negativo. El núcleo de este documento consiste en el ejercicio de la autonomía del enfermo. La Resolución 1.995/2012 del Consejo Federal de Medicina establece los criterios para que cualquier persona -mayor de edad y plenamente consciente -pueda definir, junto con su médico, los límites terapéuticos en la fase final de su vida. El documento es opcional y puede llevarse a cabo en cualquier momento de la vida y la misma manera modificada o revocada en cualquier forma y tiempo. El propósito de este artículo es discutir los beneficios, obstáculos y las limitaciones considerando la gran cantidad de investigaciones realizada sobre el tema y las experiencias positivas y negativas de otros países, con el fin de aportar a la discusión sobre su utilización de manera efectiva en Brasil. Palabras-clave: Directivas anticipadas. Autonomía personal. Bioética. AbstractThe advance directive: benefits, obstacles and limits The concept of advance directives emerged in response to the technological progress and aggressive medical treatment being employed in ambiguous situations, as in the case of a bad prognosis. The core of this document is the exercise of the patients´ autonomy. The Federal Council of Medicine´s 1.995/2012 Resolution establishes the criteria for anyone -provided that the patient is legally old enough and fully aware -to be able to choose together with his/her doctor the therapeutic limits at the end of life. The document is optional and may be completed at any time in life and, in the same way it can be modified or cancelled at any time. The purpose of this article is to consider its benefits, obstacles and limits considering the vast amount of researches carried out on this theme and the positive and negative experiences from other countries in order to contribute to the discussion about its effective use in Brazil.

Desafios da implementação das diretivas antecipadas de vontade à prática hospitalar

“…The importance of making informed and shared decisions by the health professionals who assists patients is essential for quality care and outcomes. Patient participation in treatment leads to better outcomes, which meets the traditional belief that the maintenance of health depends on care based on good and comfortable relationships between doctors and the patients (12) . Few people write a document or leave explicit instructions; in addition, designated persons in charge may not be available when needed or may be unable to make good decisions for patients, or may still have conflicts of interest, for example, from the perspective of receiving an inheritance or being promoted in a family business.…”

“…However, despite difficulties in utilization of ADW, it appears that their use will increase, moving the focus of debate to their effective use. It is therefore important that these documents incorporate a process that fosters open dialogue between families, health professionals and patients, in order to reflect patients' real needs, beliefs, values, care goals and preferences (12) . The present study is based on the principlism approach (13) , primarily the concept of autonomy, which relates to the rights to self-government, privacy, individual choice, and freedom of will -being the engine of one's own behavior (13) .…”

A experiência do comitê de bioética de um hospital público

“…The Living Will is considered a way to protect autonomy and respect values and choices of the patient 36,38 . However, it should be taken into consideration that competent people may not always be able to make decisions about their future, since these decisions can be based on an imaginary concept of how the future would be 38 .…”

“…The Living Will is considered a way to protect autonomy and respect values and choices of the patient 36,38 . However, it should be taken into consideration that competent people may not always be able to make decisions about their future, since these decisions can be based on an imaginary concept of how the future would be 38 . Thus, taking into account the considerations of these authors, the answers to the questionnaires show a balanced position on the topic, taking into account the progress that the Advance Directives represent, but also the associated risks.…”

Editorial

“…Several of these works expound on the subject in its most general aspects, such as how to communicate bad news in oncology 15 or the correct completion of the death certificate 16 . Others explain in detail ethical standards of professional behavior in extremely delicate situations for the patients and their families, such as the moment of the end of life [16][17][18][19][20][21][22] .…”