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Abstract(s)
A espécie humana é agora confrontada com longevidade e realidades demográficas, que obrigam a percorrer um caminho novo, desconhecido. Do progresso científico em geral, da genética e da biotecnologia em particular irão surgir novos desafios bioéticos e civilizacionais. A medicina confronta-se já hoje com novos desafios. O desafio demográfico, os doentes são cada vez mais velhos, e com menor reserva fisiológica. O desafio epidemiológico, doentes portadores de várias doenças crónicas simultaneamente. O desafio tecnológico em que o avanço da capacidade técnico-científica quase permite mascarar a morte. É necessário individualizar em cada doente a opção de tratamento mais adequado, para evitar obstinação terapêutica. E o desafio bioético, que consiste em exercer e pensar a medicina respeitando cada vez mais a autonomia da pessoa doente.Os trabalhos efectuados permitiram objectivar que em Portugal, no período de 2000 a 2010, os doentes com mais de 75 anos de idade admitidos em cuidados intensivos quase duplicou.Permitiram também perceber que o respeito pela autonomia, particularmente do doente com doença crónica avançada, é um percurso que urge melhorar, nomeadamente na ponderação atempada da vontade do doente vir a ser admitido em cuidados intensivos na fase avançada das suas doenças. Por outro lado,a constatação que os profissionais de saúde não pretendem para si próprios serem admitidos em cuidados intensivos em caso de doença crónica avançada, nem efectuar terapêuticas de resgate em caso de doença oncológicaavançada, mas no entanto propõem estas intervenções aos doentes, é revelador da necessidade de melhorar a comunicação, para reforçar a confiança na relação médico-doente. Quando confrontados com situações clinicas reais, em decisões clinicas “life saving” os bioeticistas privilegiam sempre a autonomia da pessoa doente, excepto se se tratar de uma situação clínica que simultaneamente ameaça a vida e em que a capacidade de decisão do doente for questionável. Já os doentes e seus familiares mostraram uma tolerância selectiva a uma medicina mais paternalista, em caso de risco eminente de morte. Por último, a publicação do livro “Reanimar?”, pretendeu informar os cidadãos da realidade da Medicina Intensiva nos nossos dias, e quais as questões éticas associadasa esta especialidade médica. Essencialmente informar, para que as pessoas possam formar convicções.Acredito que a Medicina e os médicos saberão posicionar-se em defesa da vida, e aprender sempre a cuidar melhor. A Bioética continuará a ser um pilar fundamental nessa melhoria. Privilegiar a autonomia e o reforço da relação médico-doente serão os instrumentos desta mudança.
The human species is now confronted with longevity and demographic realities which oblige us to pursue a new path, an unknown path. From scientific progress in general, as well as from genetics and particularly from biotechnology, new bioethical and civilizational challenges will arise.Medicine is confronted with new challenges at the present moment. The demographic challenge: patients are increasingly older and with a lesser physiological reserve. The epidemiologic challenge: patients carrying several chronic diseases simultaneously. The technological challenge: the significant advance of the technical and scientific capability which enables the masking of death; it is necessary to individualize, for each patient, the most appropriate treatment option to avoid therapeutic fixation. The bioethical challenge: to apply and think a medical practice which respects the patient’s autonomy. The studies accomplished show that in Portugal, between the years of 2000 and 2010, patients over 75 years of age admitted in intensive care units almost doubled. The studies also showed that the respect for the patient’s autonomy, particularly of the patient with advanced chronic disease, requires improvement, namely regarding the timely consideration of the patient’s will to eventually be admitted in intensive care at a more advanced stage of the illness. On the other hand, studies evidenced that healthcare professionals do not wish to be admitted for intensive care in case of advanced chronic disease, nor perform rescue therapies in case of advanced oncological disease, but nonetheless these healthcare professionals recommend these therapies and procedures to their patients. This makes clear that there is a significant necessity to improve communication and strengthen the trust in the doctor-patientrelationship.When confronted with real clinical situations, in clinical “life saving” decisions, bioethicists always give greater importance to the autonomy of the patient, except if the clinical situation is simultaneously life threatening and the patient’s ability to make a decision is questionable. The actual patients and their families showed a selective tolerance when it comes to a more paternalistic medicine, in cases of imminent risk of death. Lastly, the publishing of the book “Reanimar?” aimedto inform the general population about the reality of Intensive Medicine nowadays and what are the ethical questions associated to this medical specialty. Hopefully, to inform will enable the citizens to shape their own convictions.I believe that Medicine and doctors will know how to position themselves in a way that advocates for life and allows for continual learning and better caring. Bioethics will continue to be a fundamental pillar in this betterment. To attribute greater importance to the patient’s autonomy and the strengthening of the doctor-patient relationship will be the instruments of this change.
The human species is now confronted with longevity and demographic realities which oblige us to pursue a new path, an unknown path. From scientific progress in general, as well as from genetics and particularly from biotechnology, new bioethical and civilizational challenges will arise.Medicine is confronted with new challenges at the present moment. The demographic challenge: patients are increasingly older and with a lesser physiological reserve. The epidemiologic challenge: patients carrying several chronic diseases simultaneously. The technological challenge: the significant advance of the technical and scientific capability which enables the masking of death; it is necessary to individualize, for each patient, the most appropriate treatment option to avoid therapeutic fixation. The bioethical challenge: to apply and think a medical practice which respects the patient’s autonomy. The studies accomplished show that in Portugal, between the years of 2000 and 2010, patients over 75 years of age admitted in intensive care units almost doubled. The studies also showed that the respect for the patient’s autonomy, particularly of the patient with advanced chronic disease, requires improvement, namely regarding the timely consideration of the patient’s will to eventually be admitted in intensive care at a more advanced stage of the illness. On the other hand, studies evidenced that healthcare professionals do not wish to be admitted for intensive care in case of advanced chronic disease, nor perform rescue therapies in case of advanced oncological disease, but nonetheless these healthcare professionals recommend these therapies and procedures to their patients. This makes clear that there is a significant necessity to improve communication and strengthen the trust in the doctor-patientrelationship.When confronted with real clinical situations, in clinical “life saving” decisions, bioethicists always give greater importance to the autonomy of the patient, except if the clinical situation is simultaneously life threatening and the patient’s ability to make a decision is questionable. The actual patients and their families showed a selective tolerance when it comes to a more paternalistic medicine, in cases of imminent risk of death. Lastly, the publishing of the book “Reanimar?” aimedto inform the general population about the reality of Intensive Medicine nowadays and what are the ethical questions associated to this medical specialty. Hopefully, to inform will enable the citizens to shape their own convictions.I believe that Medicine and doctors will know how to position themselves in a way that advocates for life and allows for continual learning and better caring. Bioethics will continue to be a fundamental pillar in this betterment. To attribute greater importance to the patient’s autonomy and the strengthening of the doctor-patient relationship will be the instruments of this change.
Description
Keywords
Cuidados intensivos Comunicação Bioética Autonomia Relação médico-doente End-of-lifecare Bioethics Autonomy Communication Doctor-patient relationship