“Quando ninguém se entende”: conflitos bioéticos num caso real de fim de vida

Abstract

Introduction: The technical-scientific evolution of the last decades is reflected in the extension of life expectancy, in the reduction of the mortality rate due to infectious diseases and in the increase in mortality due to chronic-degenerative diseases. Added to this is the formation of medical education, increasingly equipped with a model oriented towards the use of highly sophisticated technologies, seeming to neglect the traditional field of the doctor-patient relationship. When the ultimate goal is the cure, death is considered a failure, an unacceptable result. Despite all the effort and technology used, death remains an inevitable outcome. The sick person, when in the background, ceases to be the protagonist of his story. Bioethics is a branch of knowledge that aims to indicate the limits and purposes of man's intervention in life, based on recognition for the dignity of the Human Person. “What should i do against what can I do?” End-of-life care commonly involves ethical issues that lead health professionals, patients and family members to face dilemmas, conflicts. Aim: This paper’s purpose is to show how challenging the decision-making process can be for those involved, namely health professionals, family members and users. Materials and methods: Facing a real case, ethical principles are presented and developed respecting the perspective of bioethics. Results: Starting with the conceptions of dignity, as well as possible weaknesses, covering more technical aspects such as the adequacy of therapeutic effort and proportionality of interventions, contemplating the concepts of obstinacy and therapeutic futility, exploring the dimension of autonomy (including some of its legal aspects) and ending in the field of justice and equity. Having these in hands, it becomes clear the complexity that the decision-making process gains when the humane and multidimensional aspect of the person who suffers, the patient (and family and their loved ones), is called into question. Conclusion: The considerations listed by the bioethical principles help us to base our professional actions, in order to, assist and consider, the environment and principles of the patient, the patient’s family and closed ones along with ours, as an assistance team. Resulting in the neglection of simple and absolute certainties, the lessening of doubts regarding this process and the election of the best possible answer for that specific patient, team and the context that surrounds them. Similarly, on this particular end of life situation, the concept of palliative care is highlighted as a tool of similar impact.