Cuidados paliativos e obstinação terapêutica

: decisões em fim de vida

Abstract

The countless scientific and technological advances of the twentieth century in the medical field have made the concept of “healing” gain the upper hand in the context of acute diseases, leaving to death the last word only in chronic and evolutionary diseases. Having thus been glorified, the culture of healing (seen as a victory) has created feelings of defeat and frustration in the face of death, and has led health care professionals to pursue healing and cure at all costs, postponing death as long as possible. In this context, the use of all available means to extend life has started to be questioned, with the distinction being drawn first between ordinary and extraordinary means and, then, between proportionate and disproportionate means. In the meantime, the term “futility” was adopted. A means is considered futile if it proves unable to achieve the intended result: benefitting the patient. This work intends to reflect on the criteria that should guide the decision-making process of “withholding” or “withdrawing” treatments to terminal patients. The methodology used is based on the integrative review of, and the critical reflection on, the articles published on this subject along five years (2007 to 2011) in the following journals: Hastings Center Report, British Medical Journal and Medicine, Health Care and Philosophy. As a result of this analysis, six main discussion themes were identified: (1) the concept of futility (therapeutic obstinacy and palliative care); (2) the conflict between the patient’s autonomy and rights on the one hand and, on the other, the health care personnel’s responsibility and duties; (3) the importance of communication between health care personnel and patient in the decision-making process; (4) the decision-making criteria on withholding or withdrawing treatments; (5) the principle of the double effect; (6) and, finally, the interruption of artificial nutrition and hydration.

Date of Award	2013
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	José Almeida (Supervisor)