Conspiração do silêncio: análise bioética a partir de um caso clínico

Abstract

Introduction: Good communication in palliative care is a powerful instrument. It aims to alleviate suffering without eliciting misunderstandings or fear. It should convey serenity and trust. The collusion of silence is a major barrier to the end of life caring process. For the family, keeping the silence about the situation aims to protect the patient’s psychological well being without undue stress. Caught between the two parties, the health professional must consider the constraints that challenge ethical principles, and legal and deontological norms. Bioethical reasoning helps us to consider the conflicts and problems we face in our professional activity. Aim: To develop a reflection based on the principles of bioethics about a situation of collusion of silence. Materials and Methods: Ethical discussion originating in a clinical case, based in a literature review. Discussion: Ethical reasoning is guided by the respect towards the human being – unique, multidimensional and posessing inherent dignity. Dignity is assumed as an ethical, moral and legal principle. The collusion of silence from the standpoint of ethical principles is the leitmotif of a reflexion on a common situation in clinical practice. This situation deprives the patient from exercising his/her autonomy and from receiving fair and holistic care. Conclusion: Withholding information from the patient challenges the ethical principle of human dignity, depriving him/her of the free use of autonomy to decide on the best course to follow. Ethical principles are indissociable and must be approached as a whole. The right to clear information is essential for conscious choices from the patients.