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

Abstract

Resumo Tomar decisões diante de problema moral na prática clínica tornou-se aspecto de suma importância para todos os profissionais envolvidos no cuidado da saúde. Este estudo considera esse contexto de incertezas, em que se discutem reais benefícios e acesso às novas tecnologias em saúde, e parte do pressuposto que qualquer deliberação em (bio)ética clínica resulta do princípio de que respeito pelo ser humano é indispensável para o agir correto. Este artigo tem como proposta 1) identificar na literatura alguns dos aspectos que transpassam e angustiam os profissionais de saúde e/ou pesquisadores na prática clínica, e 2) apresentar sucintamente reflexões ou abordagens correlacionadas ao processo decisório em (bio)ética clínica em relação aos casos identificados. O caminho percorrido neste estudo diz respeito à revisão da literatura científica com estratégia de busca definida.

Dilemas de profissionais de unidade de terapia intensiva diante da terminalidade

“…The behavior and attitude of intensivists seem to be based on personal values, and there is no certainty about the limit of their action, when to take palliative actions and with what focus. These doubts were also identified in the studies by Motta and collaborators 18 and Moritz collaborators 16 . It is observed that the fear of legal reprimand interferes with the removal of futile measures, even with the certainty that avoiding dysthanasia is a necessary ethical action 16 .…”

“…The context of the ICU brings complex bioethical dilemmas to intensivists, which permeate the areas of medicine, nursing, physiotherapy, and psychology. These points, reported in several studies, include: establishing the most appropriate intervention according to the patient's general health 13,14 , nutrition/hydration 13,14 , communication of bad news 11,15 , family participation in decisions 16,17 , interaction of professionals with relatives of the patient 18 and court decisions to admit patients 16 , cardiopulmonary resuscitation 16 , vasoactive drugs 16 , mechanical ventilation 16,17 , dialysis methods 16,17 , antibiotics 16,17 , blood transfusion and blood products 16,17 , end-of-life dignity [15][16][17] , respect for patient autonomy [13][14][15][16][17] , and disclosure of the diagnosis of AIDS to family members 16,17 .…”

Dilemas Éticos Vivenciados Pela Equipe De Enfermagem No Cuidado Perioperatório Frente Às Iatrogenias/ Ethical Dilemms Experienced by the Team Nursing in Perioperative Care in Front of Iatrogenias

“…A tomada de decisões frente aos dilemas éticos é fundamental o conhecimento e reflexão da bioética principialista, cujos princípios são autonomia, justiça, beneficência e não-maleficência. (MATTA, et al, 2016;SIQUEIRA-BATISTA, et al, 2014).…”

Management of bed availability in intensive care in the context of hospitalization by court order

“…The nurses 'discourse regarding the need to deal with conflicts arising from uncertainty and inconsistent messages about the patients' real prognosis, also reports to the patient's advocacy, as this professional needs to guarantee the best care available, both for through the monitoring of available treatment, which is sometimes not immediately offered to the patient, as in situations of futility of certain treatments and palliative care. The ICU nurse will not always be able to resolve all the family members' demands and expectations, but they must be responsible for indicating to the family which means they can use and making sure that the family is having access to these means (36)(37)(38) .…”