Diretivas antecipadas de vontade em geriatria

Abstract

Resumo Diretivas antecipadas de vontade representam as decisões sobre cuidados e tratamentos que um paciente deseja receber se incapacitado de expressar sua vontade. Foi avaliado o entendimento de acompanhantes de idosos (n=66) em ambulatório geriátrico, professores (n=60) e alunos de medicina (n=72) quanto a essas diretivas, a intenção de fazer o documento e as condutas durante essa situação. Os resultados mostram que somente 20% dos participantes sabem ou ao menos têm ideia do que sejam essas diretivas. A maioria dos pacientes em estado terminal (72%) prefere falecer em casa, recebendo cuidados paliativos; 32% preferem o hospital; e 45% aceitam ser levados à terapia intensiva. Poucos optam por essa manifestação de vontade, mesmo após explicações. Mais da metade (56%) confia que equipes médicas respeitarão suas decisões, e 83% confiam em familiares. Conclui-se que o assunto deve ser mais discutido na sociedade, principalmente nas áreas de ensino e assistência à saúde.

Can Bioethics Protect the Holders of Compromised Decisional Competence?

“…Other factors need to be addressed for low adherence to ADW. It was observed that even after explaining their applicability and importance, there was low adherence, and the lack of knowledge about the topic is significant even among physicians and medical students [16]. With this situation, the dissemination of the ADW becomes more difficult and, culturally, there is no habit of talking about finitude.…”

“…The question of finitude becomes a distant subject, moved to the hospital, away from the social sphere, also stimulated by technology, which gives the sensation of omnipotence and control, and may lead to the use of futile treatments (not aimed at the patient's well-being) and disproportionate (dysthanasia), in addition to turning ADWs into a distant and unnecessary [16] subject. In our understanding, these issues need to be worked out and doctors need to be trained to deal with the terminality of life.…”

Terminality Advance Directives and Nursing Practice in Brazil: Bioethical Issues

“…In Brazil, as being a very recent topic, there is little research that explains the ADs and the understandings of health professionals and society on the theme [15].…”

Advance directives of patients: process of implementation by palliative care teams

“…The main aim is to promote quality of life, understanding that patients have adequate control of their symptoms, die at the right time, as well as preserving their autonomy (7) . Therefore, advance directives (AVD) are inserted in this context, which seek to legitimize the wishes of patients who face a serious or irreversible disease, through what was reported by them or by their designated representative (8) .…”