Iniciar ou não a ventilação mecânica invasiva – uma aplicação dos quatro princípios éticos

Introduction: Medical decision regarding withholding treatment is a true ethical challenge. Contemplation over autonomy, beneficence, non-maleficence, and justice can guide us through this decision to reach the best possible clinical outcome. Aim: To promote a more adequate clinical decision, based on the four ethical principles. Material and Methods: Through a clinical case illustration of idiopathic pulmonary fibrosis, a reflection based on the four ethical principles about initiation or withholding of invasive mechanical ventilation was intended. For that effect, a classic review of the literature was made regarding the four ethical principles and the initiation of invasive mechanical ventilation in idiopathic pulmonary fibrosis. Discussion: After a multidisciplinary ethical and clinical reflection, it was considered that the patient would not benefit from invasive mechanical ventilation. The patient was informed of his actual state of disease and initiation of comfort measures was agreed, including high-flow oxygen therapy. Conclusion: The application of the four ethical principles gives a moral, fundamental and mutual language and structure, which should be complement with a compassive support of the family, an enlightening communication and an essential information sharing. An early follow-up by a palliative care team is of the essence.