临床研究与生物伦理学杂志

抽象的

Healthcare Professionals’ Perspectives on End-of-Life Care According to Autonomy of Practical Reason

Goncalves AM, Vieira A, Vilaça A, Goncalves MM, Meneses R

Nowadays, innovative medical technologies almost mask death, although they are not free of ethical concerns. Regarding end-of-life decisions, publications demonstrate that doctors don’t intend for themselves what they practice with patients.

We aimed to assess health professionals’ perspectives about their own end-of-life decisions, asking them “In case of advanced oncological disease, would you prefer rescue or comfort therapy?” and “In case of advanced chronic disease, would you prefer admission in an Intensive Care Unit (ICU) or palliative care?”.

The sample included 57% doctors. 80% of all participants chose comfort therapy and 84% chose palliative care. Nurses chose comfort therapy and palliative care more frequently than doctors (p<0.05); both doctors and nurses from surgical areas preferred rescue therapy and ICU admission (p<0.05); more than half of pediatricians answered rescue therapy and ICU admission, this trend was also observed in oncologist/palliative care doctors and surgeons, with a statistical difference (p<0.05) compared to other doctors; on the opposite, 90% from Emergency and Intensive Medicine doctors answered comfort therapy and palliative care (p<0.05).

Communication with patients and families must be more effective, making them understand that the appropriate clinical decision is the most ethically correct. Death is not something to be avoided at all costs, but rather a moment on life cycle. These issues should be discussed in advance, anticipating the possible need for admission to ICU, rescue therapy or setting limits and gently stops.