Diretivas antecipadas de vontade: percurso histórico na América Latina

Abstract

Resumo As diretivas antecipadas de vontade são instrumento para garantir ao paciente o direito de decidir sobre seus cuidados de saúde, especialmente os relacionados ao fim da vida. Neste artigo, por meio de revisão integrativa da literatura realizada entre dezembro de 2017 e janeiro de 2018, objetivou-se compreender o uso desse instrumento e traçar seu percurso histórico nos países da América Latina que já têm legislação consolidada, como Porto Rico, Argentina, México, Uruguai e Colômbia. No Brasil, como ainda não há lei sobre o tema, as diretivas são tratadas e discutidas pela Resolução 1.995/2012 do Conselho Federal de Medicina, o que pode gerar insegurança jurídica nos envolvidos. Observou-se, como característica comum nos países estudados, dificuldade quanto à divulgação e utilização desse recurso.

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

“…Using accessible language by health professionals in the exercise of informing patients about what is relevant in their health situation allows their decisions to be made consciously (10) , a characteristic that is inherent to the practice of PC. However, most health professionals, specifically physicians and assistant nurses, do not adequately inform patients about what ADV is about despite recognizing its importance (28) .…”

Implementation of early will directives: facilities and difficulties experienced by palliative care teams

“…The ability to resolve difficult situations was reported by this study's participants as a facilitator in the implementation of advance directives, as a document that legally supports health workers, as well as patients, when facing complications and decisions involving conflicts (17)(18) . This subject needs to be discussed in Brazil, considering the ethical conflicts that permeate procedures intended to respond to a terminal condition (18) .…”

“…One of the difficulties faced in the process of implementing AHDs is the family's resistance to accepting and allowing the death of a patient, which is permeated by the shallow or even nonexistent discussion about human finiteness. The conflicts experienced concern the understanding that the patients should not know information about their prognosis, the difficulty in respecting individual autonomy and the different opinions that emerge in the family group: Family members' difficulty to respect patients' autonomy regarding their choices (C. 1.2) When the patient is no longer lucid or numb and the family' s opinions are divided (F.9.1) Family members often make it difficult because they usually do not want the patient to know the prognosis (G. 2.1) In the context of AHDs, one of the barriers faced in their approach is the reluctance of health professionals in caring for patients in cases of imminent death (17) . The study participants mentioned that the care team professionals hinder the implementation process of AHDs when they deny human finiteness and perform care that will not modify the course of the disease, a factor that may be associated with the Western culture of denial of death, which makes the patients and their family members suffer due to the search for conducts that prolong life, even in the face of a disease that has no prospect of cure (20) .…”

Conhecimento dos discentes de um curso de enfermagem acerca do testamento vital / Nursing student’s knowledge about the living will

“…Essa divisão foi estabelecida no Patient Self-Determination-Act, legislação que regulamenta tal recurso nos EUA. A existência de um documento não anula o outro e também é possível que eles coexistam (9) . O mandato duradouro é a nomeação de uma pessoa de confiança pelo responsável do mandato, que deverá ser consultado pelos médicos, quando for necessário tomar alguma decisão sobre os cuidados médicos ou esclarecer alguma dúvida sobre o TV e o responsável do mandato não puder mais manifestar sua vontade.…”