Princípios e valores implicados na prática da sedação paliativa e a eutanásia

Abstract

Este estudo buscou compreender os sentidos atribuídos, pelos profissionais de saúde, à prática da sedação paliativa no processo de morrer, as relações desta prática com a eutanásia, bem como os valores considerados importantes e que subsidiam a equipe de cuidados paliativos na tomada de decisão. Trata-se de uma pesquisa exploratória e descritiva de abordagem qualitativa, baseada na hermenêutica dialética. Os resultados indicam que os sentidos atribuídos pelos profissionais entrevistados acompanham o desenvolvimento científico, os quais têm buscado esclarecer os fatos clínicos de cada processo de tomada de decisão e os valores implicados, seguindo a evolução da reflexão ética sobre a prática da sedação paliativa e eutanásia. No âmbito da reflexão ética, os princípios não são vistos como absolutos, pois, ao considerarem os valores, os profissionais analisam as circunstâncias e as consequências que permeiam as decisões.

Prevalence of palliative sedation in the State of São Paulo: an emerging medical demand

“…In spite of the subtle boundaries between palliative sedation and euthanasia reported in the literature and potential misunderstanding of both practices, (14,15) findings of this study suggest healthcare professionals participating in this survey were able to differentiate between them, a factor that may legitimate the use of palliative sedation in eligible patients. Similar findings have been reported elsewhere: (15,19) health professionals working in an oncologic palliative care hospital sector (15) and those working or having worked in specialized palliative care centers (19) were able to clearly distinguish between both terms, and referred cited ethics as the foundation supporting the practice of palliative sedation.…”

“…In contrast, euthanasia is defined as the act of accelerating death of a patient by means of lethal doses of drugs and is intended to deliberately end life to interrupt suffering. (14,15) In Brazil, discussions involving this technique are recent, (16) and specific guidelines addressing palliative sedation indications are lacking. In 2009, palliative care was included as a fundamental principle in the Code of Medical Ethics by the Federal Medical Council and, in 2011, Palliative Medicine was officially recognized as a medical specialty.…”

Espiritualidade nos cuidados paliativos: questão de saúde pública?

“…Chaplains could contribute singularly and significantly to the patient, their family and the team itself. This support is illustrated in a narrative recorded in a study that investigated principles and values involved in the practice of palliative sedation (although not the main focus, the spirituality emerged in the results) 60 . The research evaluates the case of a patient with extreme pain who decides not to undergo palliative sedation, probably due to religious convictions.…”

“…The research evaluates the case of a patient with extreme pain who decides not to undergo palliative sedation, probably due to religious convictions. The narrator claims to be frustrated with the decision, but accepts it in the name of the bioethical principles such as respect for autonomy and religious values: if the patient (…) wants to die with suffering, we work with the team and his decision is respected 61 . Another interviewee writes: and then it turns out that the one who suffers is the one who has all the principles of PC and believes that something could be done to alleviate the suffering 61 .…”

Espiritualidade em cuidados paliativos no Brasil: revisão integrativa de literatura

“…Por exemplo, em situações de tomada de decisão onde as crenças espirituais/religiosas têm predominância, pacientes demonstram confiança e abertura para discussão das opções de tratamento com o/a assistente espiritual especializado/a. Profissionais da saúde constatam a força das crenças religiosas em tomadas de decisão em saúde, por exemplo, na sedação paliativa (Eich et al, 2018), e mesmo em tratamentos invasivos (Elliott et al, 2012;Maessen et al, 2009;Johnson et al, 2016).…”