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Abstract(s)
Introdução: A decisão médica de não iniciação de terapêutica constitui um verdadeiro desafio ético. A ponderação sobre a autonomia, beneficência, não maleficência e justiça pode guiar-nos nesta decisão para alcançar o melhor desenlace clínico possível. Objetivo: Promover a decisão clínica mais adequada, baseando-se nos quatro princípios éticos. Materiais e Métodos: Através da ilustração de um caso clínico de fibrose pulmonar idiopático, pretende-se uma reflexão sobre a iniciação ou não de ventilação mecânica invasiva. Para esse efeito, fez-se uma revisão clássica da literatura sobre os quatro princípios éticos e a instituição de ventilação mecânica invasiva na fibrose pulmonar idiopática. Discussão: Após reflexão clínica, consideramos que o Senhor J. não beneficiaria da instituição de ventilação mecânica invasiva. Informou-se o Senhor J. da sua condição de doença e concordou-se em instituir medidas de conforto, incluindo oxigénio de alto fluxo. O acompanhamento da equipa de cuidados paliativos ocorreu na fase terminal da doença. Conclusão: A aplicação dos quatro princípios éticos fornece uma linguagem e estrutura analítica moral, básica e comum, que deve ser complementada por um suporte compassivo dos familiares, comunicação esclarecedora e partilha de informação essencial. O acompanhamento precoce por uma equipa de cuidados paliativos é essencial.
Introduction: Medical decision regarding withholding treatment is a true ethical challenge. Contemplation over autonomy, beneficence, non-maleficence, and justice can guide us through this decision to reach the best possible clinical outcome. Aim: To promote a more adequate clinical decision, based on the four ethical principles. Material and Methods: Through a clinical case illustration of idiopathic pulmonary fibrosis, a reflection based on the four ethical principles about initiation or withholding of invasive mechanical ventilation was intended. For that effect, a classic review of the literature was made regarding the four ethical principles and the initiation of invasive mechanical ventilation in idiopathic pulmonary fibrosis. Discussion: After a multidisciplinary ethical and clinical reflection, it was considered that the patient would not benefit from invasive mechanical ventilation. The patient was informed of his actual state of disease and initiation of comfort measures was agreed, including high-flow oxygen therapy. Conclusion: The application of the four ethical principles gives a moral, fundamental and mutual language and structure, which should be complement with a compassive support of the family, an enlightening communication and an essential information sharing. An early follow-up by a palliative care team is of the essence.
Introduction: Medical decision regarding withholding treatment is a true ethical challenge. Contemplation over autonomy, beneficence, non-maleficence, and justice can guide us through this decision to reach the best possible clinical outcome. Aim: To promote a more adequate clinical decision, based on the four ethical principles. Material and Methods: Through a clinical case illustration of idiopathic pulmonary fibrosis, a reflection based on the four ethical principles about initiation or withholding of invasive mechanical ventilation was intended. For that effect, a classic review of the literature was made regarding the four ethical principles and the initiation of invasive mechanical ventilation in idiopathic pulmonary fibrosis. Discussion: After a multidisciplinary ethical and clinical reflection, it was considered that the patient would not benefit from invasive mechanical ventilation. The patient was informed of his actual state of disease and initiation of comfort measures was agreed, including high-flow oxygen therapy. Conclusion: The application of the four ethical principles gives a moral, fundamental and mutual language and structure, which should be complement with a compassive support of the family, an enlightening communication and an essential information sharing. An early follow-up by a palliative care team is of the essence.
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Keywords
Cuidados paliativos Ética baseada em princípios Fibrose pulmonar idiopática Não iniciação de terapêutica Ética clínica Palliative care Principle-based ethics Idiopathic pulmonary fibrosis Withholding treatment Clinical ethics