Ordem de não reanimar pacientes em fase terminal sob a perspectiva de médicos

Abstract

The do-not-resuscitate order is the explicit statement by patients with advanced disease in progression refusing cardiopulmonary resuscitation. This study aimed to describe the attitude of physicians in relation to the this order and the need for its regulation. A questionnaire was applied to 80 physicians in the medical bureau of the Regional Council of Medicine of Joacaba/SC, Brazil. It was found that 90% of the respondents knew the meaning of do-not-resuscitate, 86.2% agreed to respect it, 91.2% considered it important to be registered in medical records and 92.5% understood as opportune the issuance of a regulation in this regard. It was concluded that most doctors knew about the do-not-resuscitate order, agreed to respect it, valued its registration in medical records and wanted its regulation by the relevant bodies. Keywords: Terminally ill. Bioethics. Resuscitation orders. Heart massage. Respiration, artificial. Medical futility. ResumoOrdem de não reanimar pacientes em fase terminal sob a perspectiva de médicos Ordem de não reanimar consiste na manifestação expressa da recusa de reanimação cardiopulmonar por paciente com doença avançada em progressão. Objetivou-se descrever a atitude dos médicos em relação à ordem de não reanimar e à necessidade de sua normatização. Foi aplicado questionário a 80 médicos inscritos na delegacia do Conselho Regional de Medicina de Joaçaba/SC, Brasil. Verificou-se que 90% dos participantes conheciam o significado dessa ordem, 86,2% concordavam em acatá-la, 91,2% consideravam importante seu registro em prontuário e 92,5% consideravam oportuna a emissão de normatização a respeito. Concluiu-se que a maioria dos médicos tinha conhecimento sobre Ordem de Não Reanimar, concordava em respeitá-la, valorizava seu registro em prontuário e desejava a normatização por parte dos órgãos competentes. Palavras-chave: Doente terminal. Bioética. Ordens de não ressuscitar. Massagem cardíaca. Respiração artificial. Futilidade médica. ResumenLa orden de no reanimar a los pacientes en fase terminal bajo la perspectiva de los médicos La orden de no reanimar es la manifestación expresa de rechazo de la reanimación cardiopulmonar por parte de pacientes portadores de una enfermedad avanzada en progresión. Este estudio tuvo como objetivo describir la actitud de los médicos con respecto a esta orden y la necesidad de su regulación. Se aplicó un cuestionario a 80 médicos inscriptos en el distrito del Consejo Regional de Medicina de Joaçaba/SC, Brasil. Se encontró que el 90% de los encuestados conocían el significado de esta orden, el 86,2% estaban de acuerdo en cumplirla, el 91,2% consideraban importante el registro en el historial médico y el 92,5% juzgaban oportuna la existencia de una regulación al respecto. Se concluyó que la mayoría de los médicos tenía conocimiento de la orden de no reanimar, estaba de acuerdo en respetarla, valoraba su registro en el historial médico y deseaba su regulación por parte de las instituciones competentes. Palabras clave: Enfermo terminal. Bioética. Órdenes de...

Percepção de pacientes oncológicos sobre terminalidade de vida

“…The reflection on this theme is not frequent in the literature. A previous study, conducted in the same region, showed that 10% of the physicians did not know the term 5 , showing that its approach by medical schools is not systematic. The lack of ethical and legal orientation is a factor that probably contributes to the lack of knowledge in Brazil, raising the need for regulation.…”

“…The Carta dos Direitos dos Usuários da Saúde (Health Users' Rights Charter) 4 assured to the patients the right to choose the place of death, appointment of a representative and the possibility of refusing treatment. Concerning the order not to reanimate, there is no explicit official guideline in Brazil, but there are ethical 5 and legal 4 norms with the goal of preventing the practice of dysthanasia. In this context, the importance of investigating the perception of patients in relation to different aspects of health care arises, especially when there is no therapeutic possibility.…”

Limitação do suporte de vida na terapia intensiva: percepção médica

“…In addition, it concludes that the moment is opportune to elaborate ethical guidance on the order not to reanimate in Brazil, which fills the current regulatory gap 13 .…”

“…However, it was pointed out the need to regulate the decision. Even in the case of progressive disease in terminal stage, it is important not to reanimate only upon request or family consent, although they agree that the physician should take part in the decision 13 .…”

“…In other words, "not to reanimate" in the context of terminality is nowadays a standard of good medical practice and is established as a procedure in cases of end-stage metastatic neoplasia not only in Brazil but also in Europe bioethical principle of non-maleficence, since it aims to minimize suffering and avoid dysthanasia 13 .…”