Ética na decisão terapêutica em condições de prematuridade extrema

Abstract

ResumoOs limites de viabilidade na prematuridade e a sobrevivência com mínimo de sequela são temas atuais de grande importância ética. A prematuridade extrema pode resultar em inúmeras sequelas e danos crônicos que limitam a funcionalidade. Ao se optar pelo prolongamento da vida de recém-nascidos muito imaturos, há maior exposição do prematuro e da família a situações de dor, desconforto e estresse. A presente revisão trata dos aspectos éticos relacionados a essa tomada de decisão considerando o limite de viabilidade e as sequelas neuropsicomotoras decorrentes da prematuridade extrema. Atualmente, a questão gira em torno da importância da valorização não só da sobrevivência desses prematuros, mas também da manutenção de sua qualidade de vida, uma vez que são mais predispostos a sequelas em curto, médio e longo prazos. Palavras-chave: Prematuro. Ética. Recém-nascido de peso extremamente baixo ao nascer. Desenvolvimento infantil. ResumenÉtica en las decisiones de tratamiento en condiciones de prematuridad extrema Los límites de la viabilidad de la prematuridad y la supervivencia con secuelas mínimas son las principales cuestiones éticas de actualidad . La prematuridad extrema puede dar lugar a numerosas secuelas y daños crónicos que limitan la funcionalidad. Cuando se opta por la prolongación de la vida de los recién nacidos muy inmaduros, aumenta la exposición del prematuro y de la familia a situaciones de dolor, malestar y estrés. Esta revisión discute los temas éticos relacionados con esta toma de decisión teniendo en cuenta el límite de la viabilidad y las secuelas neuropsicomotoras como consecuencia de la prematuridad extrema. En la actualidad, la cuestión gira en torno a la importancia de valorar no sólo la supervivencia de los bebés prematuros, sino también el mantenimiento de su calidad de vida, ya que son más propensos a las secuelas en el corto, mediano y largo plazo. Palabras-clave: Prematuro. Ética. Recién nacido con peso al nacer extremadamente bajo. Desarollo infantil Abstract Ethics related to therapeutic decision in cases of extreme prematurity Limits of viability for premature infants and survival with minimal consequences are current themes of great importance for ethics and bioethics. Extreme prematurity may result in many consequences and chronic injuries that limit the infant functionality. When prolongation of a very immature newborn's life is opted, there is a greater exposure of premature infants and their family to pain, distress and physiological stress situations. The present review approaches ethical aspects related to this decision-making, considering the limit of viability and neuromotor sequelae derived from extreme prematurity. At present, it is considered not only the survival of extreme premature infants, but also the maintenance of their quality of life, since they are more likely to have sequelae at short, median and long time.

Tomada de decisão em (bio)ética clínica: abordagens contemporâneas

“…Although the decline in mortality of live births in extreme prematurity is evident, prolonged time in the very stressful environment of the NICU, the various moments of manipulation and even the resuscitation interventions expose the premature NB to unwanted stimuli that later will be expressed in abnormal brain and sensory development, hearing and vision loss, and language disorders 15 .…”

“…It is recognized that artificial life support without reasonable recovery expectations -in cases of severely compromised new-borns -sets (bio)ethical dilemma in clinical practice of NICU professionals, given the possibility of prolonging the suffering of the sick individual and also of their families, putting into question the very protection of human dignity of new-borns in intensive care 15,32 .…”

Editorial

“…Neither of these can do without the ethical tools inherent to focused discussions on the values intrinsic to work processes, practices and procedures, and all need this moral framework for continuous improvement. Among these contributions, it is important to mention those related to pediatrics, specifically palliative care for the newborn premature and infant patient [24][25][26][27] , which contribute greatly to the understanding of the professional and the impasses and difficulties involved in their daily practice. 28 , it is possible to admit that in certain respects, this field of study offers support to all the specialties of the Medicine II field but, contrary to what occurs with each of them, it does not count on the strong support of the respective medical societies that promote and bolster them.…”