Evaluating end of life practices in ten Brazilian paediatric and adult intensive care units

Abstract

Life support limitation decision making in Brazilian ICUs is predominantly centred on the medical perspective with scarce participation of the family, and consequently several non-coherent medical interventions are observed in patients with life support limitation.

Forgoing life support: how the decision is made in European pediatric intensive care units

“…In Northern America, parents appear to be the main decision-makers [12,13]. Conversely, in Southern Europe and Latin America, physicians still have a dominant role in EOL decisions [11,14,15].…”

The Durban World Congress Ethics Round Table IV: Health care professional end-of-life decision making

“…There are, however large differences in the practice of WH/WD in different parts of the world as evidenced by responses to several surveys that have explored physicians' practice and ethical views on the subject [13][14][15][16][17][18][19][20]. This self-reported variation in the pattern of practice of health care practitioners has been confirmed by observational studies that also demonstrate regional variations in practice [4][5][6][7][8][9][10][11][12]. Although guidelines for some jurisdictions do exist, [21][22][23][24][25] and are often useful, they sometimes lack sufficient detail to guide daily practice and seldom consider the variability inevitably introduced by cultural and regional differences.…”

“…Life-support technology has advanced, so that it is now possible to maintain vital organ function, despite the realization that a return of the patient to reasonable health and an acceptable quality of life are no longer possible. When a return to reasonable health is no longer possible, it has become common clinical practice worldwide for ICU staff to limit life-sustaining treatments (LSTs) by withholding (WH) or withdrawing (WD) LSTs [4][5][6][7][8][9][10][11][12]. There are, however large differences in the practice of WH/WD in different parts of the world as evidenced by responses to several surveys that have explored physicians' practice and ethical views on the subject [13][14][15][16][17][18][19][20].…”

Limitación del esfuerzo terapéutico en cuidados intensivos pediátricos

“…En los países de América del Norte y algunos países europeos, el principio de autonomía tiene una fuerte inlos países de Latinoamérica las perspectivas médicas son los aspectos predominantes en la toma de las decisiones. Algunos autores consideran que la decisión que se centra en aspectos médicos es sinónimo de paternalismo 7,8 . Existen estudios en Latinoamérica y Francia que describen este modelo paternalista en el proceso de toma de decisiones, con poca o ninguna consulta familiar.…”

“…Algunas investigaciones han mostrado que la forma de retiro y limitación del tratamiento de soporte vital varía según el país. En Australia, el 74% de las muertes vienen antecedidas de esta decisión, en América del Norte y Europa, el 30-65%, y en América del Sur, por el contrario, solo el 18-32% de las muertes en UCIP son precedidas de este análisis 3,4,7 . No -a la realidad latinoamericana.…”